Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy

Kayla Godfrey; Deanna McDanel; Kelly Percival; Noelle Bowdler; Donna Santillan; Amy Dowden

doi:10.1017/ash.2025.10033

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Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy

Journal article

Open access

Peer reviewed

Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy

Kayla Godfrey, Deanna McDanel, Kelly Percival, Noelle Bowdler, Donna Santillan and Amy Dowden

Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.5(1), e125

06/11/2025

DOI: 10.1017/ash.2025.10033

PMCID: PMC12171906

PMID: 40528937

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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.

Allergies

Antibiotics

Disease Prevention

Anaphylaxis

Angioedema

Best practice

Childbirth & labor

Demographics

Diarrhea

Fetuses

Gram-positive bacteria

Medical records

Obstetrics

Patients

Penicillin

Prophylaxis

Side effects

Streptococcus infections

Urticaria

UIOWA OA Agreement

Details

Title: Subtitle: Screening for penicillin allergy in obstetric patients to optimize guideline directed therapy
Creators: Kayla Godfrey - University of Iowa
Deanna McDanel - University of Iowa
Kelly Percival - University of Iowa
Noelle Bowdler - University of Iowa
Donna Santillan - University of Iowa
Amy Dowden - University of Iowa, Immunology
Resource Type: Journal article
Publication Details: Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.5(1), e125
DOI: 10.1017/ash.2025.10033
PMID: 40528937
PMCID: PMC12171906
NLM abbreviation: Antimicrob Steward Healthc Epidemiol
eISSN: 2732-494X
Publisher: Cambridge University Press
Language: English
Date published: 06/11/2025
Academic Unit: Stead Family Department of Pediatrics; Pharmacy Practice and Science; Obstetrics and Gynecology; Immunology; Internal Medicine
Record Identifier: 9984829024002771

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