Time Has Come for Routine Penicillin Allergy Testing in Obstetrics

Abstract

Objective This study evaluates penicillin allergy during pregnancy to estimate the proportion that could benefit from penicillin allergy testing. Study Design Retrospective cohort study of women with penicillin allergy that delivered from January 1, 2018 to December 31, 2018. Results Among 6,321 deliveries, 446 (7%) were identified with penicillin allergy. Nine percent (41/446) had no documentation of allergy severity. Allergies associated with intolerance, low, moderate, or high risk of anaphylaxis were reported in 6% (25/446), 40% (177/446), 32% (142/446), and 14% (61/446), respectively. Nearly 74% (330/446) received an antibiotic either antepartum, at delivery, or within 6 weeks of postpartum. The majority of women, 81% (360/446) (i.e., undocumented reactions, low, or moderate risk of anaphylaxis) would have been eligible for penicillin allergy testing. Greater appropriate utilization of antibiotics occurred in women with a high 80% (39/49) or moderate risk of anaphylaxis 70% (79/112) versus low risk of anaphylaxis 55% (64/117), history of intolerance 40% (8/20), or undocumented reaction 19% (6/32), p ≤ 0.01. Conclusion Most women who report a penicillin allergy during pregnancy would be candidates for penicillin allergy testing. With the high rate of antibiotic interventions in pregnant women who report a penicillin allergy, consideration should be given for penicillin allergy assessment.

Outpatient Penicillin Allergy Testing in Pregnant Women Who Report an Allergy

“…Another recent retrospective study of 447 women with a reported penicillin allergy stratified patient allergies to undocumented, low, moderate or high risk. 1 The authors found that 81% of women were candidates for penicillin allergy testing. 1 The implementation of penicillin allergy testing in pregnancy would affect a large proportion of reported allergic women.…”

“… 1 The authors found that 81% of women were candidates for penicillin allergy testing. 1 The implementation of penicillin allergy testing in pregnancy would affect a large proportion of reported allergic women.…”

“…Antibiotics are administered to 30–74% of women during pregnancy, for a wide variety of indications. 1 – 5 The most commonly used antibiotics include penicillin and other beta lactams, clindamycin and other macrolides, and aminoglycosides. 4 , 6 …”

“…Pregnant women with a self-reported penicillin allergy typically receive alternative antibiotics that are broader spectrum (eg, cefazolin, clindamycin, vancomycin), which increases risk for antibiotic resistance and maternal morbidity. 1 , 6 – 8 In the general population, self-reported penicillin allergy occurs in 10% of patients, however when tested, fewer than 2% have a proven (or true) allergic reaction. 9 , 10 Penicillin allergy also decreases over time, with up to 80% of patients with a confirmed penicillin allergy losing sensitization 10 years later.…”

Survey of Obstetric Providers to Assess the Knowledge and Management of a Reported Penicillin Allergy in Pregnant Women

“…Approximately 81% of reportedly allergic women would be eligible for allergy delabeling after stratifying based on their history and perceived risk. 19 Delabeling may be challenging based on the limited history evaluation reportedly performed by obstetric providers in our survey. Additionally, the majority of respondents did not feel fully prepared to prescribe antibiotics to pregnant patients with even less feeling "very prepared" after education, however, more individuals feeling somewhat prepared.…”