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While most drug hypersensitivity reactions (DHR) are caused by active ingredients, excipients may also be involved. Excipient\u2010related DHR are easily overlooked and may lead to repeated anaphylaxis in patients exposed to pharmaceutical formulations containing different active ingredients. We performed an extensive review of the literature to provide practical recommendations on when to suspect and how to diagnose and manage excipient hypersensitivity. Where literature was limited, the collective experience of the authors was taken into consideration. Excipient hypersensitivity should be suspected in patients with a history of anaphylaxis to multiple drugs with chemically unrelated active ingredients and specific drug classes such as oral laxatives and injectable depot steroids or progestogens. Polyethylene glycol, methylcelluloses, gelatine, povidone and mannitol were identified as the most common culprits of DHR. DHR evaluation should include review of the product monograph to ascertain the presence of possible culprit excipients. Specific diagnostic tests for excipients should be performed when appropriate, including skin, in\u00a0vitro and provocation testing with pure excipients and drugs with and without the excipient as controls. We provide consensus\u2010based excipient\u2010specific recommendations on diagnostic testing based on best available evidence.<\/jats:p>","DOI":"10.1111\/all.70324","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T03:36:02Z","timestamp":1775705762000},"page":"2250-2275","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Hypersensitivity to Excipients in Drugs: An\n                    <scp>EAACI<\/scp>\n                    Position Paper"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7777-4501","authenticated-orcid":false,"given":"Lene H.","family":"Garvey","sequence":"first","affiliation":[{"name":"Allergy Clinic, Department of Dermatology and Allergy Herlev and Gentofte University Hospital  Hellerup Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen 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