Clinical Impact and Management of Antibiotic Allergy in Pregnancy

We review recent literature on impact of antibiotic allergy during pregnancy, and evidence for management in those self-reporting beta-lactam allergy.

Pregnant patients report a high-rate of antibiotic allergy, similar to the general public. Historically, antibiotic allergy evaluation has been reserved for non-pregnant patients, however, growing evidence supports safety and clinical utility for allergy evaluation during pregnancy. Recent studies have supported safety of outpatient skin testing with drug challenge in those with beta-lactam allergy, with most recent findings supportive of direct drug challenge in patients with low-risk allergy phenotypes. Evaluation of allergy label during pregnancy improves first-line antibiotic use of beta-lactam antibiotics. Allergy evaluation during pregnancy is a unique opportunity for allergists to impact clinical outcomes for both maternal and neonatal outcomes. Future studies should focus on standardization of evaluation protocols, improving access to allergy evaluation, and expand knowledge on neonatal clinical outcomes.