A Randomized Trial Comparing Direct Challenges to Penicillin Skin Testing for Outpatient Low-Risk Penicillin Allergy Evaluations in Pregnancy.

BACKGROUND

The importance of penicillin allergy de-labeling in the general population is well known. Its significance is further highlighted in pregnancy because penicillin-based antibiotics are first-line therapy for most infections at the time of delivery, particularly group B Streptococcus.

OBJECTIVE

To evaluate the safety of a two-step direct challenge (DC) to amoxicillin without preceding skin testing in pregnant patients with a low-risk penicillin allergy label, regardless of trimester.

METHODS

We performed a prospective, randomized controlled trial comparing penicillin skin testing (PST) followed by an oral amoxicillin challenge versus a two-step DC to amoxicillin without preceding skin testing in pregnant patients regardless of trimester with a low-risk penicillin allergy label.

RESULTS

A total of 144 women were included in this study, 73 of whom underwent PST and 70 of whom underwent DC. Of those women, 68 (93.2%) undergoing PST had a negative evaluation for penicillin allergy compared with 70 (100%) who underwent DC. No reactions in either PST or DC groups required medical treatment or, notably, administration of epinephrine. Direct challenge took significantly less time compared with PST. Median time for PST was 75 minutes (interquartile range, 75-80 minutes) compared with 65 minutes (interquartile range, 65-70 minutes) for DCs.

CONCLUSION

For evaluation of penicillin allergy in pregnancy, we demonstrate that a DC is as safe as PST in low-risk pregnant patients.