OB/GYNs more comfortable with penicillin allergy delabeling vs. allergists, survey shows

Key takeaways:

• Only 38% of allergists felt that patients could be delabeled at any time during pregnancy.
• For OB/GYNs, barriers to penicillin allergy delabeling included access to allergists and allergist discomfort.

SAN DIEGO — OB/GYNs reported feeling more comfortable performing penicillin allergy delabeling among pregnant women compared with allergists, according to a presentation here.

Results of the survey were presented at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.

“Penicillin and beta lactams are first-line treatments for many diseases diagnosed during pregnancy, such as group B Streptococcus infections, urinary tract infections, syphilis, chorioamnionitis and cesarean section prophylaxis,” Victoria T. Nguyen, DO, an allergy/immunology fellow and physician at The Ohio State University Wexner Medical Center and Nationwide Children’s Hospital, told Healio. “Although national organizations for obstetricians have emphasized the importance of penicillin allergy delabeling for pregnant patients, standardized practice recommendations for allergists do not currently exist.”

Delabeling rates

Researchers surveyed 35 academic OB/GYNs and 32 allergists/AAAAI members to examine their current preferences and practices for evaluating penicillin allergy among pregnant patients.

Overall, 86% of OB/GYNs reported that they felt comfortable assessing penicillin allergy and 63% reported that they have referred patients to an allergist for evaluation.

Results also showed that 41% of OB/GYNs reported delabeling procedures should be performed at the earliest available appointment, followed by 32% who stated that the second trimester was most ideal, and 14% felt the first trimester was appropriate.

Conversely, 38% of allergists reported that patients should be delabeled at any time during pregnancy, whereas 28% stated that delabeling procedures should be performed postpartum.

The researchers noted that 22% of allergists reported only performing delabeling procedures during the third trimester and 28% reported only performing them if needed for acute treatment.

Among OB/GYNs, 36% denied barriers to penicillin delabeling, 36% cited difficulty referring or scheduling delabeling procedures and 14% noted previous experience with allergists who had limitations in delabeling pregnant patients, according to the researchers.

For allergists, 38% reported no barriers and 15% cited their own discomfort in penicillin delabeling.

Importance of delabeling

“If we delay allergy testing and evaluation of pregnant patients with penicillin allergy, the label remains in their chart and alternative antibiotics will be used; these may have more side effects and be less effective than using a penicillin-containing antibiotic, which is often the first line or preferred treatment,” Nguyen said. “Some providers are even hesitant to use beta lactam antibiotics like cephalosporins in patients with penicillin allergy labels, which limits the available antibiotics even further. We hope our survey results will encourage allergists to feel more comfortable with penicillin allergy evaluations earlier in pregnancy and proactively delabel pregnant patients.”

Nguyen acknowledged that the OB/GYN respondents may have been more representative of academic OB/GYN provider practices.

“We hope that standardized management recommendations and triage protocols are established in the future to increase rates of penicillin allergy delabeling in this unique patient population,” she said.