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Penicillin allergy and desensitization in serious infections during pregnancy
Insights
Oral penicillin desensitization is safe for pregnant women with penicillin allergy needing beta-lactam antibiotics for infections like syphilis or sepsis. This method effectively treats infections with minimal, manageable side effects.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Allergy and Immunology
Background:
- Penicillin allergy complicates treating antepartum infections requiring beta-lactam antibiotics.
- Accurate diagnosis of penicillin allergy is confirmed by skin testing.
Purpose of the Study:
- To evaluate the safety and efficacy of oral penicillin desensitization in pregnant women with confirmed penicillin allergy.
- To enable treatment of serious antepartum infections with necessary beta-lactam drugs.
Main Methods:
- Oral penicillin V desensitization over 4-6 hours in 15 pregnant women with confirmed penicillin allergy.
- Subsequent full-dose parenteral penicillin G or ampicillin therapy.
- Monitoring for adverse reactions and treatment outcomes.
Main Results:
- Oral desensitization was successfully completed in all patients.
- Mild cutaneous reactions (pruritus, urticaria) occurred in 33% but did not halt therapy.
- All maternal infections were clinically cured; neonates were normal.
Conclusions:
- Oral penicillin desensitization is a safe and effective strategy for pregnant women requiring beta-lactam therapy.
- This approach overcomes penicillin allergy barriers in managing antepartum infections.
- It allows for necessary antibiotic treatment with manageable adverse events.
Abstract:
Penicillin allergy presents a major obstacle to the successful management of some antepartum infections. We studied 15 pregnant women with histories of penicillin allergy confirmed by positive immediate wheal-and-flare skin tests. Thirteen had syphilis, one listeria sepsis, and one Streptococcus viridans endocarditis. Each patient was desensitized over four to six hours by oral administration of increasing doses of penicillin V. At the completion of the procedure, full-dose parenteral therapy with penicillin G or ampicillin was instituted. No extracutaneous reactions were detected. Five of the subjects (33 per cent) experienced pruritus (three) or urticaria (two), but no interruption of desensitization or therapy was necessary. All clinically apparent maternal infections were cured. The pregnancy complicated by listeriosis aborted in the first trimester. The 11 neonates delivered to date are normal. These results indicate that oral desensitization is an acceptably safe approach to therapy in pregnant women who are allergic to penicillin and have infections that require beta-lactam drugs.