Implementing a penicillin allergy de-labelling service for the obstetric population

Abstract

<h3>Objectives</h3> Penicillin allergy is self-reported in 10% of the general population. However, 90% of them can safely tolerate penicillin. Given the negative consequences associated with an incorrect allergy status and the importance of beta-lactam antibiotics as a prophylactic measure during delivery, evaluation in the pregnant population is essential. We hypothesize that the majority of antenatal women carry unsubstantiated penicillin allergy labels. Through the combination of skin testing and drug provocation testing, we can safely remove their allergy status and influence antibiotic prescribing in labour. <h3>Methods</h3> All antenatal women (<36 weeks gestation) with a history or possible reaction to penicillin and registered delivery at a tertiary care centre were eligible for enrolment. Rolling recruitment was completed based on gestational age. Full antenatal and allergy history was taken prior to allergist-supervised skin and oral-challenge testing. Patient views on penicillin allergy were also collected. De-labelled patients will be followed up in 3–5 years to determine allergy status and subsequent antibiotic use. <h3>Results</h3> A total of 24 antenatal women (mean gestational age of 36 weeks) were enrolled between July 2019–Sept 2019. Of these, 100% (24/24) showed no hypersensitivity to penicillin testing and had their allergy de-labelled. 2/24 women were GBS positive and 100% (2/2) were successfully treated with penicillin during delivery. 9/24 required Cefazolin and did so safely. <h3>Conclusions</h3> Penicillin allergy testing is safe during pregnancy and should be routinely performed to optimize antibiotic therapy during labour. Allergist-led allergy de-labelling in a multidisciplinary clinic is an effective option to promote antimicrobial stewardship and reduce patient morbidity.