Time Has Come for Routine Penicillin Allergy Testing in Obstetrics

Area of Science:

• Obstetrics and Gynecology
• Allergy and Immunology
• Pharmacology

Background:

• Penicillin allergy is frequently reported in pregnant women.
• Accurate penicillin allergy assessment is vital for appropriate antibiotic selection during pregnancy.
• Many pregnant women with reported penicillin allergy may not require avoidance of penicillin-class antibiotics.

Purpose of the Study:

• To evaluate penicillin allergy in pregnant women.
• To estimate the proportion of pregnant women with penicillin allergy eligible for allergy testing.
• To inform clinical practice regarding penicillin allergy assessment in pregnancy.

Main Methods:

• Retrospective cohort study design.
• Analysis of delivery data from January 1, 2018, to December 31, 2018.
• Inclusion of women with reported penicillin allergy.

Main Results:

• 7% of 6,321 deliveries involved women with penicillin allergy.
• 9% lacked documented allergy severity.
• 81% of women with reported penicillin allergy were eligible for penicillin allergy testing (undocumented reactions, low, or moderate risk of anaphylaxis).
• Antibiotic utilization varied significantly based on reported allergy risk.
• Higher risk anaphylaxis groups showed greater appropriate antibiotic use.

Conclusions:

• The majority of pregnant women reporting penicillin allergy are candidates for formal penicillin allergy testing.
• Given high antibiotic use in this population, penicillin allergy assessment should be prioritized.
• Testing can help de-label women unnecessarily avoiding penicillin, optimizing antibiotic therapy.