Penicillin Allergy Assessment in Pregnancy: Safety and Impact on Antibiotic Use.

ABSTRACT Background Penicillin and other beta-lactam antibiotics are recommended for Group B Streptococcus (GBS) and Caesarian section prophylaxis, but approximately 10% of pregnant patients report a penicillin allergy. Objective To assess the safety and impact of proactive penicillin allergy evaluation in pregnant patients. Methods This was a retrospective electronic health record review of obstetrician-ordered Allergy/Immunology (AI) electronic consultations (e-consults) from September 20, 2017 through December 31, 2019. For patients whose e-consult recommended an in-person AI evaluation, testing outcomes were determined, and multivariable logistic regression models were used to compare antibiotic use between patients who did and did not receive an in-person AI evaluation. Results Of 389 obstetrician-ordered e-consults, 363 (93%) recommended an in-person AI evaluation; of these, 222 (61%) patients received an in-person AI evaluation. Of 220 (99%) patients skin tested, 209 (94%) had their penicillin allergy label safely removed. Compared to patients who did not receive an in-person AI evaluation despite it being recommended (n=141), patients with in-person AI evaluation had reduced peripartum vancomycin (aOR 0.07 [95% CI 0.01, 0.33]), clindamycin (aOR 0.17 [95% CI 0.08, 0.34]), and gentamicin (aOR 0.39 [95% CI 0.19, 0.78]) use and increased penicillin (aOR 17.95 [95% CI 6.30, 51.16]) use. The fully AI evaluated patients had increased first-line antibiotic prophylaxis for GBS (aOR 26.87 [95% CI 6.32, 114.33]) and Cesarean section (aOR 1.94 [95% CI 1.06, 3.52]). Conclusion In a sample of 220 pregnant patients with penicillin allergy histories and in-person AI evaluation, penicillin allergy testing was safe and associated with significantly reduced broad-spectrum antibiotic use and increased first-line beta-lactam antibiotic use.