Multiple Antibiotic Allergy Evaluation Strategy (MAAES): A Comparative Effectiveness Study.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42447992.
- Also identified by DOI 10.1016/j.jaip.2026.07.005.
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Abstract
Inaccurate multiple antibiotic allergy labels to first-line agents (penicillins, cephalosporins, and sulfonamides) restrict optimal therapy and often require sequential evaluations across multiple visits, delaying delabeling and increasing loss to follow-up. To conduct a comparative effectiveness study of the Multiple Antibiotic Allergy Evaluation Strategy (MAAES), comparing its effectiveness, safety, and patient-reported outcomes (PRO) with traditional sequential evaluation (non-MAAES). This retrospective cohort study (2014-2024) compared same-day multi-antibiotic testing (MAAES) with non-MAAES in patients with 2 or more low-risk labels. Multivariable regression adjusted for baseline differences and testing era. Inverse probability of treatment weighting (IPTW) and a restricted post-2020 subcohort analysis addressed selection bias and temporal shifts. Outcomes included delabeling efficacy, time to complete delabeling, loss to follow-up, relabeling, adverse events (AEs), and PRO. Baseline differences were present between the MAAES and non-MAAES groups, including penicillin anaphylaxis (1.4% vs 6.6%, P = .002), angioedema (12.4% vs 19.1%, P = .049), maculopapular rash (13.1% vs 24.3%, P = .002), and unknown sulfonamide history (9.5% vs 3.7%, P = .03). MAAES removed 97.4% of labels versus 79.6% for non-MAAES (adjusted odds ratio [aOR]: 9.41, 95% confidence interval [CI]: 5.22-16.95, P < .001). MAAES achieved faster complete delabeling (log-rank χ<sup>2</sup> = 42.4, P < .001), with 84.9% versus 21.1% delabeled at the initial visit (restricted mean survival time difference: 2.1 months). Results remained robust in post-2020 and IPTW models. Loss to follow-up (1.3% vs 17.2%; aOR: 0.06, 95% CI: 0.03-0.13, P <.001) and AEs (<1% vs 2.8%; aOR: 0.26, 95% CI: 0.09-0.78, P = .02) were significantly lower with MAAES. Favorable PRO was sustained, with no significant differences between groups. A consolidated multidrug evaluation strategy substantially improves the effectiveness of first-line antibiotic allergy delabeling while maintaining excellent safety profiles and PRO.