Background

Penicillin allergy is frequently reported. In pregnant women, reported penicillin allergy is associated with negative health outcomes and suboptimal group B streptococcal prophylaxis. For individuals having penicillin allergy, skin testing followed by an observed oral challenge is recommended. Previous data indicate a low risk of adverse reaction with skin testing in pregnant women, but the subsequent oral challenge was not routinely pursued.

Objective

To determine whether skin testing followed by the outpatient oral challenge is tolerated by pregnant women.

Methods

We conducted a retrospective review of all pregnant women who underwent penicillin allergy evaluation at an outpatient allergy and clinical immunology clinic. The patients underwent oral amoxicillin challenges based on the discretion of the allergy provider. We evaluated the index reaction history, skin test results, oral challenge results, and subsequent antibiotic exposure.

Results

A total of 46 pregnant women underwent skin testing without adverse reactions, of whom 44 patients (95.6%) received negative results. A total of 18 women (39%) completed an oral challenge without adverse reactions. Patients challenged vs not challenged did not differ in patient age, gestational age, latency since index reaction, or reaction history risk level. Notably, 28 women received intrapartum antibiotics. There was no difference in intrapartum antibiotic administration between those who did or who did not complete an in-office oral challenge (P = .90).

Conclusion

Penicillin skin testing and oral challenge in pregnant women can safely be performed in the outpatient setting. There was no difference in the intrapartum antibiotic use between women who were and those who were not challenged. Further research is needed to determine the utility of oral challenge in pregnant patients.

中文翻译：

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对青霉素过敏孕妇的门诊过敏和临床免疫学诊所进行皮肤测试和口服阿莫西林挑战。

背景

青霉素过敏常被报道。在孕妇中，据报道的青霉素过敏与不良的健康结果和乙组链球菌预防不佳有关。对于青霉素过敏的个体，建议进行皮肤测试，然后观察到口服刺激。先前的数据表明，孕妇皮肤测试不良反应的风险较低，但随后并未常规进行口服挑战。

目的

为了确定孕妇是否可以接受皮肤测试以及门诊患者进行口服挑战。

方法

我们对所有在门诊过敏和临床免疫诊所接受青霉素过敏评估的孕妇进行了回顾性研究。根据过敏者的判断，患者接受了阿莫西林口服治疗。我们评估了指数反应史，皮肤测试结果，口服攻击结果以及随后的抗生素暴露。

结果

共有46名孕妇接受了皮肤测试而没有不良反应，其中44例（95.6％）获得了阴性结果。共有18位女性（39％）完成了口试，没有不良反应。接受挑战与未接受挑战的患者在患者年龄，胎龄，自指数反应以来的潜伏期或反应历史风险水平方面均无差异。值得注意的是，有28名妇女接受了产时抗生素治疗。进行或未完成办公室内口服攻击的人之间的产前抗生素施用没有差异（P  = .90）。

结论

在门诊患者中可以安全地进行孕妇的青霉素皮肤测试和口服挑战。既往与未接受挑战的妇女之间的产前抗生素使用没有差异。需要进一步的研究来确定孕妇口服挑战的效用。