Penicillin allergy protocol reduces antibiotic exposure during pregnancy
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Most pregnant women who believed they had a penicillin allergy were not allergic and tolerated penicillin during labor, according to results of a retrospective study.
The results, presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting, also suggest a penicillin allergy protocol that avoids oral antibiotic challenges among pregnant women without a clear indication can reduce unnecessary exposure to antibiotics and may reduce infantile morbidity. According to the protocol, only women with group B Streptococcus (GBS) positivity or another need for penicillin would undergo graded oral amoxicillin challenge.
“The study was prompted by concerns for postpartum infantile morbidity associated with antibiotic administration during pregnancy,” study author Benjamin Wang, MD, an internal medicine resident at Oregon Health & Science University in Portland, told Healio.
The researchers evaluated 32 women, administering skin testing for penicillin allergy to 25 of them. All of the results were negative. Eight of the 25 patients who received skin testing had uncomplicated pregnancies, so they did not need any penicillin while they were pregnant.
Also, two of the pregnant women received antibiotics before they completed a graded oral challenge because they experienced unexpected skin lacerations related to vaginal delivery. Thirteen of them tested positive for GBS and received skin testing and an oral challenge before receiving penicillin during labor.
The remaining two patients were lost to follow-up prior to delivery.
Sometimes found in pregnant women, GBS usually doesn’t cause health problems but can be harmful to newborns. The pregnant women who tested positive for GBS or who needed penicillin were the only patients who had an oral amoxicillin challenge.
“There were no particularly surprising findings here, but we did note that it would be reasonable to reduce antibiotic administration during pregnancy to rule out penicillin allergies by only performing the graded-oral challenge step in patients who had an indication for them,” Wang said.
“Penicillin allergy testing is important for anyone who was given a penicillin allergy label as a child and still carries it as an adult,” allergist Mariana C. Castells, MD, PhD, chair of the ACAAI Task Force on Drug Allergy and director of the Drug Hypersensitivity and Desensitization Center at Brigham and Women’s Hospital in Boston, said in a press release.
“A pregnant woman with GBS may need penicillin for treatment. If she is labeled as allergic, she will be offered a less effective, and possibly more harmful, antibiotic. It is important to have penicillin de-labeling ahead of the need for penicillin,” Castells added.
The researchers said that their penicillin allergy protocol may reduce antibiotic exposure, which would reduce the risk for adverse events associated with the use of broad-spectrum antibiotics and improve antibiotic stewardship by preventing oral antibiotic challenges in pregnant women who do not have a clear indication for penicillin. It also may reduce infantile morbidity, they added.
“Based on our research, it would be reasonable to defer performing the graded-oral challenge step of penicillin allergy testing during pregnancy until there is a clinical indication for doing so, thus decreasing exposure of pregnant women to penicillin during pregnancy, which will hopefully also reduce infantile morbidity,” Wang said.
Wang also said that the next step in research would be building additional links to the types of adverse infantile outcomes associated with antibiotic administration, because there have not been many studies about these outcomes.
“Studies also correlating total amount of reduced infantile morbidity that may be associated with reduced antibiotic administration during pregnancy will also be helpful,” Wang said.
Reference:
Pregnant women with penicillin allergy label should be tested to reduce antibiotic exposure. https://annualmeeting.acaai.org/2021/pregnant-women-with-penicillin-allergy.cfm. Published Nov. 5, 2021. Accessed Nov. 5, 2021.
Perspective
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These findings add to the growing body of studies that show penicillin evaluations are safe and indicated in pregnancy. Pregnant women should be evaluated for their history of penicillin allergy because penicillin is first-line treatment for labor and delivery in pregnant women with GBS. Removing the penicillin allergy label also opens the door for use of penicillin-based antibiotics during and beyond pregnancy if indicated.
These findings also are consistent with my experience. We have a special phoneline at our office for OB/GYN offices to make timely appointments specifically for this purpose. The vast majority of pregnant women are able to tolerate penicillin, as is the case for other populations as well.
Penicillin allergy evaluations, then, should be a routine part of prenatal care in penicillin-allergic women. Penicillin evaluations also may save hospital time for newborn babies because it optimizes treatment for mothers with GBS during labor and delivery. Who wouldn’t want that?
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Wang B, et al. Abstract P175. Presented at: ACAAI Annual Scientific Meeting; Nov. 4-8, 2021; New Orleans (hybrid meeting).
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