Standards for practical management of drug hypersensitivity reactions to intravenous drugs and proactive early allergy involvement before referral: A WAO Statement

Abstract

Hypersensitivity reactions to intravenous therapies—including antibiotics, chemotherapeutics, biologics, anesthesia agents, and contrast media—pose significant challenges in acute care settings. These reactions often occur outside the purview of allergy specialists, leading to delays in recognition, suboptimal management, and inconsistent documentation. This article underscores the imperative for proactive, multidisciplinary collaboration to enhance patient safety and treatment continuity. We examine the spectrum of intravenous reactions, including anaphylaxis, highlighting the pivotal role of allergists in both acute intervention and long-term care planning. Emphasis is placed on the development of standardized protocols, the establishment of inpatient allergy consult teams, and the implementation of penicillin allergy delabeling strategies. Supplemental materials provide real-world examples from leading institutions that have successfully integrated multidisciplinary approaches, demonstrating improved outcomes through coordinated care. By proactively engaging in the creation of safety protocols, referral pathways, and joint models of care, allergy specialists can contribute significantly to safer patient environments, even before reactions occur, ensuring timely diagnosis, effective management, and optimal outcomes.