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Second\u2010line choices carry significant negative consequences, including reduced efficacy, effectiveness, and safety. This study aimed to develop a new highly specific score constructed by selecting variables assisted by artificial intelligence to identify low\u2010risk BL\u2010allergic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this study, derivation and validation of the BL\u2010predictor score were performed on a retrospective cohort of 2207 patients who underwent penicillin allergy testing at M\u00e1laga University Hospital (Spain). The development of the BL\u2010predictor encompassed expert drafting and a two\u2010step variable selection process consisting of univariate analysis and variable filtering, followed by stepwise logistic regression with resampling. To assess the efficiency, a multicentric retrospective external validation was performed in 4261 patients from six populations: Salamanca and Madrid, Spain; Nashville, United States of America; Verona, Italy; Paris, France; and Copenhagen, Denmark.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The definitive questionnaire consisted of eight items and risk points were computed from the logistic regression model as follows: +1 for reactions after first dose or in less than 1\u2009h (ITEM\u20101), +2 for anaphylaxis (ITEM\u20102); +1 for previous reaction with the culprit (ITEM\u20103); \u22121 for resolution in &gt;\u200924\u2009h (ITEM\u20104); +2 for spontaneous resolution (ITEM\u20105); \u22122 for unknown symptoms (ITEM\u20106); \u22122 for reaction occurred &gt;\u20095\u2009years (ITEM\u20107), and \u22121 for another reported drug allergy (ITEM\u20108). After establishing a threshold of \u2264\u20090 points to classify individuals with low risk, internal validation showed a specificity of 86% and a negative predictive value (NPV) of 83%. Overall multicenter external validation showed a specificity of 93%, which implies a 25% increase in specificity compared to the previously published BL decision tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This score would simplify diagnostic procedures in low\u2010risk patients, enabling rapid delabeling, potentially in non\u2010specialty settings, and reducing diagnostic costs and the negative consequences associated with incorrect antibiotic allergy labels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/all.70222","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:25:05Z","timestamp":1768814705000},"page":"2885-2897","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Development of Betalactam\u2010Predictor: A Clinical Decision Tool for Delabeling Low\u2010Risk Betalactam Allergy Patients. Initial Validation in Penicillin Allergy"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9618-4067","authenticated-orcid":false,"given":"Marina","family":"Labella","sequence":"first","affiliation":[{"name":"Allergy Unit, Hospital Regional Universitario de M\u00e1laga  M\u00e1laga Spain"},{"name":"Allergy Research Group, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga y Plataforma en Nanomedicina\u2010 IBIMA Plataforma BIONAND  M\u00e1laga Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"Allergy Research Group, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga y Plataforma en Nanomedicina\u2010 IBIMA Plataforma BIONAND  M\u00e1laga Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5309-4878","authenticated-orcid":false,"given":"Inmaculada","family":"Do\u00f1a","sequence":"additional","affiliation":[{"name":"Allergy Unit, Hospital Regional Universitario de M\u00e1laga  M\u00e1laga Spain"},{"name":"Allergy Research Group, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga y Plataforma en Nanomedicina\u2010 IBIMA Plataforma BIONAND  M\u00e1laga Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Rodr\u00edguez","family":"de Guzm\u00e1n","sequence":"additional","affiliation":[{"name":"Allergy Unit, Hospital Regional Universitario de M\u00e1laga  M\u00e1laga Spain"},{"name":"Allergy Research Group, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga y Plataforma en Nanomedicina\u2010 IBIMA Plataforma BIONAND  M\u00e1laga Spain"},{"name":"Departamento de Medicina Facultad de Medicina, Universidad de M\u00e1laga  M\u00e1laga Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0953-3025","authenticated-orcid":false,"given":"Esther","family":"Moreno","sequence":"additional","affiliation":[{"name":"Allergy Service, University Hospital of Salamanca, Salamanca, Spain Institute for Biomedical Research of Salamanca (IBSAL)  Salamanca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7777-4501","authenticated-orcid":false,"given":"Lene Heise","family":"Garvey","sequence":"additional","affiliation":[{"name":"Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Clinical Medicine Copenhagen University  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Julio","family":"Laguna","sequence":"additional","affiliation":[{"name":"Allergy Unit, Allergo\u2010 Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8889-1589","authenticated-orcid":false,"given":"Annick","family":"Barbaud","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, INSERM, Institut Pierre Louis D'epid\u00e9miologie et de Sant\u00e9 Publique, AP\u2010 HP. 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