All pregnant women with penicillin allergy ‘should have the opportunity to be evaluated’

Key takeaways:

• Childhood penicillin allergies are commonly outgrown.
• Infants born to mothers with Group B streptococcus and reported penicillin allergies had a higher risk for longer hospital stay or readmission within 1 week.

Allergist and immunologist Laura A. Wang, MD, has long had a passion for promoting women’s health and children’s health within the allergy field.

“Pregnancy is a particularly unique time when you not only get to take care of the mother, but you also have the opportunity to promote the best outcomes for a child before they are born,” Wang, assistant professor of pediatrics and allergy/immunology at University of Colorado Anschutz Medical Campus, told Healio.

In her most recent study, she and colleagues looked at the outcomes of infants born to women with reported penicillin allergies, a topic with which Wang has had personal experience.

“I had a penicillin allergy that was diagnosed in childhood, but I am no longer allergic,” she said. “It was important to me to understand my penicillin allergy status before my daughter was born so I knew what antibiotics I could take when I was pregnant.”

Wang said many people outgrow penicillin allergies or are misdiagnosed with them as children, and alternative antibiotic treatments can increase patients’ risk for infections. Penicillin is a preferred antibiotic during pregnancy, Wang said, yet most of the research about penicillin allergies have not included pregnant patients.

Wang’s study, published in The Journal of Allergy and Clinical Immunology: In Practice, found babies born to women with penicillin allergy and Group B streptococcus (GBS) colonization had a higher risk for longer hospitalization or readmission within a week of birth.

The retrospective study evaluated outcomes of 726,685 deliveries from GBS-positive mothers, comparing the 18,146 deliveries involving mothers with reported penicillin allergy to the 708,539 deliveries without. Wang and colleagues adjusted for maternal and infant characteristics and calculated the relative risk for adverse infant outcomes such as infant GBS infection, NICU admission, intubation, long hospital stay, hospital readmission within 1 week and infant death within 1 year.

Infants born to mothers with reported penicillin allergies had a higher risk for long hospital stays (adjusted RR = 1.1; 95% CI, 1-1.1) and readmission within a week of birth (aRR = 1.1; 95% CI, 1-1.1).

“Prior studies have shown that babies are likely to stay in the hospital longer if their mothers reported a penicillin allergy, but this is the first study showing they are also more likely to come back to the hospital after they go home,” Wang said. “This study emphasizes the importance of getting penicillin allergy evaluation either before pregnancy or during pregnancy because knowing the status can impact care for women and their babies.”

Wang added that studies have shown that penicillin allergy testing during pregnancy is safe.

“Allergists should partner with obstetricians and gynecologists to help facilitate penicillin allergy evaluation,” she said. “Ideally, all women who report a penicillin allergy should have the opportunity to be evaluated.”

For more information:

Laura A. Wang, MD, can be reached at lauraann.wang@childrenscolorado.org.