Penicillin allergy consultation via telehealth has ‘poor return rate’ in pregnant women

Key takeaways:

• Out of 189 pregnant women, 22.7% opted for a telehealth vs. in-person penicillin allergy consultation.
• Among those who chose the telehealth option, penicillin allergy was delabeled for 46.5% of patients.

SAN DIEGO — Nearly half of pregnant women who completed a telehealth penicillin allergy consultation did not go on to complete in-person allergy testing, according to a poster presented here.

The findings, presented at the 2025 American Academy of Allergy, Asthma and Immunology/World Allergy Organization Joint Congress, indicate a need for further research to examine the “poor return rate for further testing,” researchers concluded.

Assessing consultation uptake

“Pregnant patients benefit hugely from having their penicillin allergy evaluated and often removed from their medical record,” Margaret M. Kuder, MD, MPH, staff physician in allergy and clinical immunology at Cleveland Clinic, told Healio. “New [electronic medical record] technology makes this more accessible.”

Researchers assessed 213 pregnant women with a scheduled penicillin allergy consultation between August 2023 and February 2024 to determine how presenting the patient with both a self-scheduling and telehealth option impacts consultation uptake.

“We anticipated that many people would utilize self-scheduling and telehealth,” Kuder said.

Notably, researchers also explored how antibiotic use during labor and delivery differed between patients with a delabeled antibiotic allergy vs. patients where this type of allergy was not delabeled.

Self-scheduling, telehealth outcomes

Within the study population, 189 patients (age, 31.63 years; 87% white) fulfilled the penicillin allergy consultation with an allergy provider, whereas the remaining 24 patients (age, 31.16 years; 87.5% white) did not fulfill the consultation.

When examining the use of self-scheduling among those who fulfilled the consultation, researchers found that a larger proportion of these patients did self-schedule their appointment rather than not use this option (n = 127; 67% vs. n = 62; 33%).

For telehealth usage, more patients who fulfilled their consultation opted for the initial in-person option vs. the initial telehealth option (n = 146; 77.3% vs. n = 43; 22.7%), according to the poster.

In the initial in-person consultation group, most patients (92%; n = 134) completed allergy testing (skin testing and/or an oral challenge), leaving only 8% (n = 12) of patients that did not complete testing. In contrast, researchers reported that 53.5% (n = 23) of the initial telehealth consultation group attended allergy testing whereas the remaining 46.5% (n = 20) of these patients did not come back. Kuder told Healio this finding was surprising.

“We need to investigate this further and figure out if there is some sort of disconnect in scheduling or communication preventing the completion of the drug allergy evaluation,” Kuder said.

Among those who chose the initial telehealth consultation option, penicillin allergy was delabeled for 46.5% (n = 20) of patients, whereas this allergy was not delabeled for 53.5% (n = 23) of patients, according to the poster.

“Over half of the individuals who completed an initial telehealth evaluation did not have their penicillin allergy delabeled, many of these because they did not return for testing,” Kuder said. “Some of [the not delabeled instances] were due to never returning for the in-person visit, and some were because they only did skin testing — not oral challenge— or one person had positive testing.”

Labor and delivery data

Researchers additionally examined data for 185 patients for whom they had access to labor and delivery information and identified more patients with a delabeled vs. not delabeled antibiotic allergy (110 patients vs. 75 patients).

“Most pregnant patients in our study who completed testing had negative results and had their penicillin allergy removed from the chart,” Kuder told Healio.

According to the poster, a greater proportion of patients in the delabeled group used vs. did not use an antibiotic during labor and delivery (68% vs. 32%). This pattern differed in the group of patients not delabeled for antibiotic allergy, as slightly fewer patients did vs. did not use an antibiotic during this time (48% vs. 52%).

The most used antibiotic in both groups was cefazolin (n = 40 delabeled; n = 20 not delabeled). The poster further noted that penicillin G was the second most used antibiotic by patients in the delabeled group (n = 31), followed by non-beta lactam antibiotic (n = 3) and “other beta lactam” (n = 1).

In the not delabeled group, non-beta lactam antibiotic was the second most used antibiotic (n = 15), followed by penicillin G (n = 1). Researchers observed no use of “other beta lactam” in this group.

Moreover, researchers observed a significantly higher proportion of patients not delabled with a sub-optimal antibiotic used vs. those with a delabled antibiotic allergy (21.3% vs. 2.7%; P < .001).

“[Delabeled] patients were more likely to receive a first-line antibiotic during the labor and delivery period,” Kuder told Healio. “Future research will hopefully allow telehealth to be a more effective option as an initial evaluation for patients. Any pregnant patient with a listed penicillin allergy would benefit from an allergy evaluation.”

For more information:

Margaret M. Kuder, MD, MPH, can be reached at kuderm@ccf.org.