Penicillin Allergy in Pregnancy: A Practical Review for the Obstetrician

Penicillin allergies are commonly reported in pregnancy, yet patients are rarely truly allergic. Identification of pregnant patients who would benefit from penicillin allergy testing is an important public health initiative to reduce alternative antibiotic usage and reduce associated adverse outcomes.

This article reviews the epidemiology of penicillin allergy, the pathophysiology of allergy in general, in addition to penicillin allergy, the safety of penicillin allergy testing in pregnancy, the impact of penicillin allergy testing on maternal and neonatal outcomes, and considerations for quality improvement interventions.

Original research articles, review articles, and professional society guidelines on penicillin allergy evaluation in pregnancy were reviewed.

Penicillin allergy in pregnancy is associated with increased risks of adverse neonatal and maternal outcomes. The reviewed literature demonstrates that penicillin allergy testing in pregnancy is efficacious, with the majority of individuals undergoing penicillin allergy delabeling with low rates of allergy testing complications. In addition, penicillin allergy testing has been shown to be associated with a reduction in second-line antibiotic usage, although future studies are required to elucidate the full reduction in adverse outcomes associated with delabeling.

Penicillin allergy in pregnancy is associated with increased risk of adverse outcomes. Given that the majority of individuals can be safely delabeled, efforts to explore opportunities for increased penicillin allergy assessment should be an ardent goal.