IMPLEMENTING A REFERRAL PROTOCOL FOR PENICILLIN ALLERGY TESTING OF PREGNANT WOMEN

Abstract

<h3>Introduction</h3> Recent American College of Obstetrics and Gynecology (ACOG) guidelines advocate for the safety of penicillin allergy testing in pregnant women. Penicillin allergy de-labeling allows for preferred peripartum antibiotic therapy for Group B Streptococcus (GBS) prophylaxis and reduces IV antibiotics and neonatal ICU (NICU) care for newborns. Yet, there remains widespread hesitance to perform penicillin allergy testing on pregnant women. <h3>Methods</h3> This is a prospective cohort study. We developed a single-academic center referral protocol for pregnant patients with penicillin allergy to be evaluated by allergy and immunology (A/I) prior to delivery. The primary endpoint is rate of penicillin allergy de-labeling. Secondary endpoints included use of intrapartum antibiotics for GBS prophylaxis in the mother and IV antibiotic use in the neonates. <h3>Results</h3> The study is ongoing, and to-date we have seen 18 pregnant women in A/I clinic for penicillin allergy evaluation. Thirteen patients completed allergy testing. Of these, 11 (85%) were de-labeled and two experienced positive amoxicillin oral challenge (one delayed rash and one immediate possibly IgE-mediated symptom). Six patients have delivered, one was GBS-positive and successfully received preferred penicillin (ampicillin) for intrapartum prophylaxis without event. <h3>Conclusion</h3> Implementing a referral pathway directly from the obstetrics clinic for penicillin allergy evaluation is a streamlined method to potentially remove penicillin allergy labels in pregnant patients prior to delivery. In our study, the majority of patients were successfully de-labeled. Further data is needed to assess safety outcomes as well as use of alternative antibiotics and need for IV antibiotics in the neonate.