Improving routine prenatal penicillin allergy testing for reported penicillin allergy

Area of Science:

• Clinical Medicine
• Allergy and Immunology
• Obstetrics and Gynecology

Background:

• Self-reported antibiotic allergies are linked to increased healthcare costs, more resistant infections, and poorer health outcomes.
• Less than 5% of patients with reported penicillin allergies have a clinically significant reaction upon testing.
• Penicillin is the recommended treatment for Group B Streptococcus (GBS) in pregnant patients, necessitating allergy evaluation.

Purpose of the Study:

• To assess the safety and feasibility of penicillin allergy testing in pregnant patients.
• To evaluate the impact of allergy de-labeling on subsequent antimicrobial therapy.
• To improve guideline-adherent treatment for GBS colonization in pregnant individuals.

Main Methods:

• A quality improvement project utilized an algorithm for patient selection for penicillin allergy testing.
• Testing involved skin prick tests (benzylpenicilloyl polylysine, penicillin G potassium, amoxicillin, penicilloate), intradermal tests, and oral challenges.
• Patient outcomes were analyzed to determine the intervention's effectiveness.

Main Results:

• Of 1266 pregnant patients, 236 (19%) reported penicillin allergy; 212 were eligible for testing.
• 101 patients completed testing, with 7 (7%) testing positive and 94 (93%) testing negative and being de-labeled.
• 17 de-labeled patients with GBS colonization received intrapartum penicillin without adverse events.

Conclusions:

• Penicillin allergy testing is a safe and feasible approach for pregnant patients reporting allergies.
• Allergy de-labeling enables safe, guideline-recommended antimicrobial use during labor and delivery.
• Further research is needed on cost-effectiveness and long-term impact on care episodes.