Safety and Outcomes for Penicillin Skin Testing in Pregnancy

Abstract

Penicillin allergy in pregnant women is associated with increased morbidity and use of less effective antibiotics to treat group B streptococcus infections. Although the American College of Obstetrics and Gynecology recommends evaluation of women with penicillin allergy prior to delivery, testing in pregnancy remains infrequent. We studied the largest known cohort to date of pregnant women who underwent penicillin allergy evaluation to assess the effectiveness and safety of penicillin skin test and oral drug challenge in pregnancy. A retrospective review was conducted of pregnant women with penicillin allergy referred by obstetrics/gynecology to the University of Pennsylvania allergy clinic. We evaluated the index drug reaction, penicillin skin prick and intradermal testing, oral challenge outcomes, and antibiotic use after testing. Eighty-three pregnant women were identified with average gestational age of twenty-six weeks. The culprit drugs included penicillin (33%), amoxicillin (40%), and unknown (36%). Index reaction occurred greater than five years ago in 91% of women. 95% of index reactions were cutaneous or unknown. Skin testing was negative in seventy-six (92%) patients, positive in one (1%) patient, and inadequate or equivocal in six (7%) patients. Eighty women underwent graded challenge to penicillin V or amoxicillin. Seventy-nine tolerated the challenge. One developed isolated itching. Thirty-five patients used intrapartum antibiotics. Penicillin was used in 43% of deliveries. Two patients subsequently had drug reactions. Penicillin allergy evaluation, including drug challenge, can be safely conducted in pregnant women. Similar to the general population, most pregnant women with penicillin allergy have negative testing, and can receive penicillin intrapartum.