The purpose of this study is to present current best practises and recent advancements in the use of risk stratification as a tool for drug provocation testing (DPT). The researchers were particularly interested in evaluating bogus penicillin allergy labels. The inherent dangers of DPT are reduced by appropriate patient selection. A thorough history will reveal characteristics of a potentially severe index reaction, as well as substantial medical comorbidities that may raise the risks of DPT. Such patients must undergo skin testing and/or in vitro testing before being considered for a DPT. However, there is growing evidence that patients who do not have these characteristics may be able to move directly to DPT. This has been extensively proved with bogus penicillin allergy labels, and a number of risk stratification algorithms have been used to identify the ‘low-risk’ patient. Such approaches have shown improved outcomes and lower costs without jeopardising patient safety.

Risk stratification methods may allow for the well-tolerated and successful ‘delabelling’ of low-risk patients, putting less strain on already restricted resources.