Obstetric Penicillin Allergy Evaluations

Abstract

BackgroundPenicillin allergy is reported in 5-15% of the world population, with 3-10% of pregnant women reporting the same. However, more than 90% of these patients can tolerate penicillin after appropriate evaluation. Penicillin is indicated for various issues that arise in pregnancy, and a history of allergy can have negative individual and public health consequences. ObjectiveTo prospectively evaluate the feasibility, safety, and select obstetric outcomes of obstetric penicillin allergy evaluations arranged through a direct referral phone line from obstetric practices to an employed allergy/immunology practice. MethodsPatients were referred via direct phone line for evaluation during their antenatal visits between May 2019 and May 2022. Patients skin prick testing, and those with negative PST were given an amoxicillin challenge. In select cases, direct oral challenge was performed with a low-risk history. Data were analyzed using descriptive statistics. For detailed Methods, please see the Methods section in this article's Online Repository at www.jacionline.org ResultsOf the 324 patients referred between May 2019 to May 2022, 251 (77.5%) presented for in-office evaluations. 239/251 (95.2%) patients underwent penicillin skin testing followed by oral challenge if negative, 12 (4.8%) patients underwent direct challenge without skin testing, and all of them passed the challenge. Of the patients undergoing penicillin skin testing, 230 (97.2%) had negative skin testing and 229 tolerated subsequent oral amoxicillin doses, with 1 patient experiencing a delayed reaction to the amoxicillin. The patients who presented for evaluation had more people who lived in Zip codes that have been attributed to have high socioeconomic status, compared to the no-show group (73.7% vs 63.3%). ConclusionWe are the largest study to date to demonstrate the safety and feasibility of a phone line for obstetric penicillin allergy referrals. We demonstrate a better show rate than previous analyses, with most of these patients successfully de-labeled.