Penicillin Allergy Delabeling Can and Should Be Performed in Pregnant Patients: A Work Group Report of the AAAAI Women's Health in Allergy and Immunology and Adverse Reaction to Drugs, Biologics, and Vaccines Committees.

Abstract

Penicillin allergy is frequently reported yet rarely confirmed in pregnant women, similar to the general population. Historically, there has been hesitation to perform penicillin allergy testing in pregnant patients due to perceived risk to the patient and fetus in the event of an allergic reaction. Given the multiple clinical indications for penicillin in pregnancy and delivery, there are also risks of using non-first-line antibiotics; thus clarity is needed regarding the safety of undergoing penicillin allergy testing during pregnancy. A workgroup subcommittee of members from the American Academy of Allergy, Asthma & Immunology committees on Women's Health in Allergy/Immunology and Adverse Reactions to Drugs, Biologics, and Vaccines was convened, and a survey of current allergist practices as well as a scoping review of the literature was conducted. Although survey respondents reported mixed comfort with testing, evidence from numerous recent studies representing hundreds of pregnant patients demonstrates that penicillin allergy testing can be safely performed via an oral challenge with or without preceding skin testing. To implement this testing in clinical practice, allergists and immunologists can learn from the clinical experience of numerous institutions that have reported a successful approach to offering definitive allergy evaluation in this population.