Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy
Abstract Objective: To assess the safety of penicillin allergy evaluation and testing in obstetric patients utilizing oral drug challenges with or without prior penicillin skin testing (PST) depending on characteristics of the patient’s medication reaction, and to determine whether removal of the...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25100338/type/journal_article |
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| _version_ | 1850213055115296768 |
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| author | Kayla Godfrey Deanna McDanel Kelly Percival Noelle Bowdler Donna Santillan Amy Dowden |
| author_facet | Kayla Godfrey Deanna McDanel Kelly Percival Noelle Bowdler Donna Santillan Amy Dowden |
| author_sort | Kayla Godfrey |
| collection | DOAJ |
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Abstract
Objective:
To assess the safety of penicillin allergy evaluation and testing in obstetric patients utilizing oral drug challenges with or without prior penicillin skin testing (PST) depending on characteristics of the patient’s medication reaction, and to determine whether removal of the drug allergy label led to an increased use of guideline-recommended antibiotic prophylaxis for group B Streptococcus (GBS).
Design and Setting:
This retrospective cohort study evaluated obstetric patients cared for at the University of Iowa Health Care who were identified as having a penicillin allergy label between June 1, 2021 and July 1, 2023.
Patients:
A total of 728 patients were identified to have a penicillin allergy and 299 patients were seen in the drug allergy clinic (DAC) for allergy evaluation.
Results:
Of patients seen in the DAC for allergy evaluation, 270 (90.3%) had their allergy de-labeled after undergoing an oral drug challenge with or without PST. No patients experienced an IgE-mediated anaphylactic reaction to an oral drug challenge. Patients received penicillin G more often for GBS prophylaxis during labor when they had their drug allergy removed in the DAC compared to those who were not seen for allergy evaluation (87.5% vs 24.5%, P < 0.001).
Conclusions:
This study supports the safety of drug allergy testing in obstetric patients. Most patients are appropriate candidates for a direct oral challenge only or PST followed by an oral challenge. Identifying and testing penicillin allergic obstetric patients prior to delivery resulted in an increase in use of first-line guideline-recommended antibiotic prophylaxis for GBS during labor.
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| format | Article |
| id | doaj-art-766587b3d1b64f1f8a69a162e007c537 |
| institution | OA Journals |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-766587b3d1b64f1f8a69a162e007c5372025-08-20T02:09:12ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.10033Screening for penicillin allergy in obstetric patients to optimize guideline directed therapyKayla Godfrey0https://orcid.org/0009-0008-9449-9776Deanna McDanel1https://orcid.org/0009-0000-6450-0475Kelly Percival2Noelle Bowdler3Donna Santillan4https://orcid.org/0000-0002-6180-9714Amy Dowden5University of Iowa Health Care, Iowa City, IA, USAUniversity of Iowa Health Care, Iowa City, IA, USA University of Iowa College of Pharmacy, Iowa City, IA, USAUniversity of Iowa Health Care, Iowa City, IA, USAUniversity of Iowa Health Care, Iowa City, IA, USA University of Iowa Carver College of Medicine, Iowa City, IA, USAUniversity of Iowa Health Care, Iowa City, IA, USA University of Iowa Carver College of Medicine, Iowa City, IA, USAUniversity of Iowa Health Care, Iowa City, IA, USA University of Iowa Carver College of Medicine, Iowa City, IA, USA Abstract Objective: To assess the safety of penicillin allergy evaluation and testing in obstetric patients utilizing oral drug challenges with or without prior penicillin skin testing (PST) depending on characteristics of the patient’s medication reaction, and to determine whether removal of the drug allergy label led to an increased use of guideline-recommended antibiotic prophylaxis for group B Streptococcus (GBS). Design and Setting: This retrospective cohort study evaluated obstetric patients cared for at the University of Iowa Health Care who were identified as having a penicillin allergy label between June 1, 2021 and July 1, 2023. Patients: A total of 728 patients were identified to have a penicillin allergy and 299 patients were seen in the drug allergy clinic (DAC) for allergy evaluation. Results: Of patients seen in the DAC for allergy evaluation, 270 (90.3%) had their allergy de-labeled after undergoing an oral drug challenge with or without PST. No patients experienced an IgE-mediated anaphylactic reaction to an oral drug challenge. Patients received penicillin G more often for GBS prophylaxis during labor when they had their drug allergy removed in the DAC compared to those who were not seen for allergy evaluation (87.5% vs 24.5%, P < 0.001). Conclusions: This study supports the safety of drug allergy testing in obstetric patients. Most patients are appropriate candidates for a direct oral challenge only or PST followed by an oral challenge. Identifying and testing penicillin allergic obstetric patients prior to delivery resulted in an increase in use of first-line guideline-recommended antibiotic prophylaxis for GBS during labor. https://www.cambridge.org/core/product/identifier/S2732494X25100338/type/journal_article |
| spellingShingle | Kayla Godfrey Deanna McDanel Kelly Percival Noelle Bowdler Donna Santillan Amy Dowden Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy |
| title_full | Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy |
| title_fullStr | Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy |
| title_full_unstemmed | Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy |
| title_short | Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy |
| title_sort | screening for penicillin allergy in obstetric patients to optimize guideline directed therapy |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25100338/type/journal_article |
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