Penicillin allergy testing in pregnancy improves maternal and neonatal clinical outcomes.

BACKGROUND

Penicillin allergy is commonly reported in pregnancy, a time of high antibiotic utilization wherein β-lactam antibiotics have multiple indications. Unverified penicillin allergy leads to alternative antibiotic receipt and is associated with increased rates of cesarean delivery, prolonged maternal hospitalization, increased infectious complications, and increased number of antibiotics courses, while neonates born to those with penicillin allergy have higher infection rates, hospitalization time, and readmissions.

OBJECTIVE

Our primary aim was to evaluate the impact of penicillin allergy evaluation on antibiotic utilization through 30 days postpartum. Our secondary aim was to compare maternal and neonatal clinical outcomes to those who did not undergo penicillin allergy evaluation (usual care group).

METHODS

Participants in this prospective cohort study underwent single outpatient visit for penicillin allergy evaluation with supervised drug challenge to amoxicillin after negative skin prick and intradermal skin testing during second or third trimester. Antibiotic utilization, length of stay, and other outcomes for mother and infant were compared to a usual care group by linear regression models.

RESULTS

Forty-six participants completed outpatient penicillin allergy evaluation. Compared to 105 pregnant patients in the usual care group, tested individuals were more likely to be married and to have private insurance, and they had significantly increased perinatal β-lactam receipt (96% vs 38%, P < .001). Tested patients had 69% decreased odds of cesarean delivery (odds ratio = 0.31; 95% confidence interval, 0.13. 0.72), while infants of tested patients had 69% lower mean length of stay (odds ratio = 0.31; 95% confidence interval, 0.18, 0.55) and 59% lower odds of high neonatal sepsis scores (odds ratio = 0.41; 95% confidence interval, 0.19, 0.86).

CONCLUSIONS

Proactive penicillin allergy evaluation during pregnancy benefits both maternal and neonatal clinical outcomes and is safe to perform.