Skin testing and oral amoxicillin challenge in the outpatient allergy and clinical immunology clinic in pregnant women with penicillin allergy

Kuder, Margaret; Lennox, Maria G.; Li, Manshi; Lang, David M.; Pien, Lily

doi:10.1016/j.anai.2020.08.012

Cited by 26 publications

(14 citation statements)

References 29 publications

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“…Recent publications on this topic include retrospective reviews of pregnant patients receiving penicillin skin testing followed by an oral challenge to confirm tolerance of penicillin,20 29 and a systematic literature review positing that desensitisation should be used more frequently in the pregnant population to mitigate the sequelae of unverified penicillin allergies 30. Our findings align with the conclusions of other papers: penicillin skin testing can be safely performed in pregnancy and a negative test allows providers to safely follow guideline-driven antimicrobial therapy and use first-line antibiotics in labour and delivery for GBS-positive patients 20 29 31. In addition, our publication provides a structured way to approach this evaluation in pregnant patients.…”

Section: Discussionsupporting

confidence: 80%

“…2 16 18 Penicillin allergy testing has been studied and documented to be safe for pregnant patients. [19][20][21] With the goal of improving antimicrobial stewardship for our prenatal patients, we undertook a quality improvement project to identify patients with a self-reported penicillin allergy who could be treated with this first-line antibiotic in labour. We report real-world results from this project implementation.…”

Section: What This Study Addsmentioning

confidence: 99%

“…The negative predictive value of this method of testing exceeds 98% 2 16 18. Penicillin allergy testing has been studied and documented to be safe for pregnant patients 19–21…”

Section: Introductionmentioning

confidence: 99%

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Improving routine prenatal penicillin allergy testing for reported penicillin allergy

et al. 2022

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BackgroundPatients with self-reported antibiotic allergies have a higher cost of care, more frequent infections with resistant bacteria and worse health outcomes than patients without antibiotic allergies. Ultimately, less than 5% of patients who report a penicillin allergy have a clinically significant immune-mediated hypersensitivity reaction when tested. As 10%–30% of the population of pregnant patients are colonised for group B Streptococcus (GBS) and guidelines recommend penicillin as the treatment of choice for GBS, current recommendations support penicillin allergy testing in pregnant patients who report an allergy.Methods and interventionIn this quality improvement project, nursing staff used an algorithm outlining inclusion and exclusion criteria to determine which patients were eligible to have penicillin allergy testing completed. Penicillin allergy testing consisted of a skin test using benzylpenicilloyl polylysine (Pre-Pen), penicillin G potassium, amoxicillin and alkaline hydrolysis mix (penicilloate) as a prick skin test, followed by intradermal skin test and finally an oral challenge with either amoxicillin or penicillin. Patient outcomes were analysed to evaluate the impact of the intervention.ResultsOf the 1266 patients receiving prenatal care during the intervention, 236 (19%) reported a history of penicillin allergy, and 212 if these were eligible for testing. 150 of the eligible patients were offered penicillin allergy testing. 101 patients (67%) completed testing and 49 (33%) declined testing. Seven patients (7%) had positive penicillin allergy testing, while 94 patients (93%) had negative penicillin allergy testing and were immediately de-labelled as penicillin allergic. Seventeen of the de-labelled patients subsequently tested positive for GBS colonisation, and all received intrapartum penicillin without adverse events.ConclusionsPursuing penicillin allergy testing for pregnant patients with reported penicillin allergy is a safe and feasible approach, allowing for allergy de-labelling and safe, guideline-driven antimicrobial therapy during subsequent labour and delivery hospitalisations. Cost-effectiveness of the allergy testing and impact on later episodes of care should be further investigated.

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Section: Discussionsupporting

confidence: 80%

Section: What This Study Addsmentioning

confidence: 99%

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Improving routine prenatal penicillin allergy testing for reported penicillin allergy

et al. 2022

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“… 12 Only moderate risk patients need to be evaluated with penicillin skin testing for penicillins prescribing, not all of patients must be performed skin test before penicillins prescribing. 13 14 …”

Section: Discussionmentioning

confidence: 99%

Antimicrobial prescribing for children in China: data from point prevalence surveys in 18 tertiary centres in China in 2016–2017

Zhang

et al. 2022

BMJ Open

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ObjectivesThe reports on evaluating the classification of antibiotic agents prescribed for Chinese children by combining WHO’s and China’s administrative categories were rare. This study aimed to investigate the pattern of antimicrobial agents prescribing for Chinese children in 2016.Settings18 tertiary centres from nine provinces located in northern, southern, eastern and western China.ParticipantsThe antimicrobial prescribing data from the children admitted in medical wards, surgical wards and intensive care units were collected and analysed. A total of 3680 antibiotic prescriptions for Chinese children were included in the analysis.Primary and secondary outcome measuresOne-day point-prevalence surveys (PPSs) on antimicrobial prescribing were conducted among hospitalised children in China between 1 February 2016 and 28 February 2017. Five hospitals participated in the first PPS, 13 hospitals in the second PPS, 17 hospitals in the third PPS and 18 hospitals in the fourth PPS. Patterns of antibiotic use with a drug utilisation of 90%, Anatomical Therapeutical Chemical Classification, WHO Access, Watch and Reserve (AWaRe) (version 2019) and antibiotic classification in China were described retrospectively.ResultsA total of 4442 children and 3680 antibiotic prescriptions for Chinese children were included in the analysis. 2900 (65.3%) children received at least one ongoing antibiotic during the survey days. On the basis of WHO AWaRe classification, the proportion of antibiotics in the Watch group was 76.5% (2814/3680). According to the Management of Antibiotic Classification in China, 56.8% (2089/3680) and 16.1% (594/3680) of antibiotic prescriptions in the Restricted group and the Special group, respectively, were included into broad-spectrum antibiotics. The most common indication for antibiotics was bacterial lower respiratory tract infection (2044/3680, 55.5%).ConclusionsThe use of broad-spectrum antibiotics was frequent and excessive in hospitalised children in China in 2016.

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“…The safety of penicillin allergy verification testing (i.e., penicillin skin testing followed by oral amoxicillin challenge) in pregnancy has been illustrated in multiple studies. 20,[22][23][24][25] Wolfson et al also demonstrated a reduction in alternative antibiotic use as a result of penicillin allergy verification testing program in pregnancy. 23 Referral to allergists for penicillin allergy verification testing is recommended by ACOG and should be performed if resources are available.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Survey of Obstetric Providers to Assess the Knowledge and Management of a Reported Penicillin Allergy in Pregnant Women

et al. 2022

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Background: Penicillin allergy is the most commonly reported drug allergy in the United States, however less than 10% of individuals labeled with a penicillin allergy are truly allergic. A reported penicillin allergy in pregnancy is associated with adverse maternal and perinatal outcomes. Despite recommendations for penicillin allergy testing in pregnancy, limited literature regarding obstetric providers’ comfort and knowledge in addressing penicillin allergy and referral patterns exists. Objective: To survey obstetric providers to assess their clinical practice patterns and baseline penicillin allergy knowledge, identify potential knowledge gaps in management of pregnant patients with reported penicillin allergy, and measure the impact of an educational intervention on provider knowledge and practice patterns. Study Design: An anonymous, electronic 23 question survey administered to all obstetric providers at a single academic medical center assessed obstetric provider characteristics, self-reported antibiotic practice patterns, and antibiotic allergy knowledge before (June 19, 2020) and after (September 16, 2020) a penicillin allergy educational intervention, which consisted of multiple small-group educational sessions and a culminating departmental educational session. Discrete knowledge comparison by provider type and experience level was performed using chi square tests pre and post-intervention. Results: Of 277 obstetric providers invited, 124(45%) responded pre-intervention and 62(22%) post-intervention. 27% correctly identified the percentage of patients labeled penicillin allergic who would tolerate penicillins, 45% identified cephalosporin cross-reactivity, 59% understood penicillin allergies can wane, and 54% identified penicillin skin testing(PST) as a valid allergy verification tool. Among 48 respondents who attended educational sessions and responded post-intervention, their knowledge of penicillin allergy waning (79% pre-education vs 98% post-education, p<0.01) and PST as a valid tool for penicillin allergy verification (50% pre-education vs 83% post-education, p<0.01) improved. Conclusions: Knowledge gaps related to penicillin allergy exist among obstetric providers. Educational initiatives may improve provider knowledge, identification of patients requiring penicillin allergy evaluation, and reduce referral barriers.

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Skin testing and oral amoxicillin challenge in the outpatient allergy and clinical immunology clinic in pregnant women with penicillin allergy

Cited by 26 publications

References 29 publications

Improving routine prenatal penicillin allergy testing for reported penicillin allergy

Improving routine prenatal penicillin allergy testing for reported penicillin allergy

Antimicrobial prescribing for children in China: data from point prevalence surveys in 18 tertiary centres in China in 2016–2017

Survey of Obstetric Providers to Assess the Knowledge and Management of a Reported Penicillin Allergy in Pregnant Women

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