Abstract
Objective
This study sought to evaluate available evidence of the safety of penicillin skin
testing (PST), challenge, and desensitization in pregnancy, with efforts to improve
perinatal care for patients with a penicillin allergy history and mitigate the negative
sequelae of unverified penicillin allergy labels.
Methods
A systematic review of studies was conducted using Cochrane Library, Medline, EMBASE,
and International Pharmaceutical Abstracts. Included were peer-reviewed studies without
date restrictions, published in English or French, relating to PST, challenge, or
desensitization in pregnancy. Editorials, opinion pieces, and letters were excluded.
Review authors independently screened citations and full-text articles, extracted
data, and conducted quality assessment. Given the heterogeneity of study designs,
a narrative synthesis was conducted.
Results
The search identified 1195 references, of which 18 studies met inclusion criteria.
In total there were 231 patients with varying histories of penicillin allergy, the
majority requiring treatment for syphilis or group B streptococcal (GBS) disease during
pregnancy. Of the 203 participants who underwent PST, 83.7% had negative test results.
Allergy-related reactions were rare in PST (1.5%) and challenge (0%), and although
these reactions were more common in desensitization (19.7%), most were benign. Among
the 231 cases, only one adverse pregnancy outcome was reported (0.4%).
Conclusion
This review demonstrates that the known prevalence of true penicillin allergy extends
to pregnant women. PST and desensitization can be safely applied during pregnancy
and are tools that should be used more frequently. Further data on the safety of challenge
during pregnancy are recommended.
Résumé
Objectif
Dans un effort pour améliorer les soins périnataux offerts aux patientes qui présentent
des antécédents d'allergie à la pénicilline et pour atténuer les séquelles qui résultent
de la non-vérification des étiquettes d'allergie à la pénicilline, l'étude visait
à évaluer les données probantes disponibles sur l'innocuité des tests cutanés à la
pénicilline, les tests de provocation et la désensibilisation chez les femmes enceintes.
Méthodologie
Une revue systématique d'études a été effectuée au moyen des bases de données Cochrane
Library, Medline, EMBASE et International Pharmaceutical Abstracts. Des études révisées
par des pairs ont été retenues sans restriction de date, publiées en français ou en
anglais et portant sur les tests cutanés à la pénicilline, les tests de provocation
ou la désensibilisation chez les femmes enceintes. Les éditoriaux, les articles d'opinion
et les lettres ont toutefois été exclus. Les auteurs de la revue ont examiné indépendamment
les citations et articles en version intégrale. Ils ont extrait les données, puis
réalisé une évaluation de la qualité. Ils ont enfin effectué une synthèse narrative
en raison de l'hétérogénéité des méthodologies d'étude.
Résultats
La recherche a relevé 1 195 références; de ce nombre, 18 études respectaient les critères
d'inclusion. Au total, 231 patientes présentaient divers antécédents d'allergie à
la pénicilline. La majorité d'entre elles nécessitaient un traitement de la syphilis
ou du streptocoque du groupe B (SGB) pendant la grossesse. Des 203 participantes ayant
subi un test cutané à la pénicilline, 83,7% ont obtenu un résultat négatif. Les réactions
allergiques étaient rares relativement au test cutané à la pénicilline (1,5%) et au
test de provocation (0%) et bien qu'elles aient été plus fréquentes dans les cas de
désensibilisation (19,7%), la plupart de ces réactions étaient bénignes. Parmi les
231 cas, une seule issue de grossesse défavorable a été rapportée (0,4%).
Conclusion
Cette revue démontre que la prévalence connue d'allergies réelles à la pénicilline
concerne aussi les femmes enceintes. Le test cutané à la pénicilline et la désensibilisation
peuvent être pratiqués en toute sécurité pendant la grossesse et sont des outils dont
le personnel soignant devrait se servir plus souvent. Il est recommandé de poursuivre
les recherches sur l'innocuité du test de provocation pendant la grossesse.
Keywords
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REFERENCES
- Antibiotic allergy.Lancet. 2019; 393: 183-198
- Penicillin and beta-lactam allergy: epidemiology and diagnosis.Curr Allergy Asthma Rep. 2014; 14: 1-7
- Evaluation and management of penicillin allergy: a review.JAMA. 2019; 321: 188-199
- Controversies in drug allergy: beta-lactam hypersensitivity testing.J Allergy Clin Immunol Pract. 2019; 7: 40-45
- Penicillin allergy testing should be performed routinely in patients with self-reported penicillin allergy.J Allergy Clin Immunol Pract. 2017; 5: 333-334
- Anaphylaxis during pregnancy.J Allergy Clin Immunol. 2012; 130: 597-606
- Prevention of perinatal group B streptococcal disease - revised guidelines from CDC, 2010.MMWR Morb Mortal Wkly Rep. 2010; 59: 1-31
- 2015 sexually transmitted diseases treatment guidelines.Centers for Disease Control and Prevention, Atlanta, GA2015 (Available at:)https://www.cdc.gov/std/tg2015/default.htmDate accessed: December 12, 2019
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.J Clin Epidemiol. 2009; 62: e1-34
- A 25-year-old woman reporting an allergy to penicillin.CMAJ. 2015; 187: 1065-1066
- Penicillin desensitization in the treatment of syphilis during pregnancy.Am J Perinatol. 1997; 14: 553-554
- Penicillin allergy and desensitization in serious infections during pregnancy.N Engl J Med. 1985; 312: 1229-1232
- ‘Doctor, I think I'm allergic to penicillin’ - primary syphilis in the third trimester.Sex Transm Infect. 2016; 92: A88
- Fetal response to intramuscular epinephrine for anaphylaxis during maternal penicillin desensitization for secondary syphilis.J Matern Neonatal Med. 2018; 31: 2223-2225
- Intravenous penicillin desensitization and treatment during pregnancy.JAMA. 1986; 256: 2561-2562
- Oral desensitization to penicillin for the treatment of pregnant women with syphilis: a successful program.Rev Bras Ginecol Obstet. 2018; 40: 43-46
- Persistence of positive skin test 25 years after a penicillin-induced anaphylaxis.World Allergy Organ J. 2015; 8: A87
- Successful treatment of pregnant women with syphilis and penicillin allergy.World Allergy Organ J. 2015; 8: A231-A232
- Intradermal test is a relevant biomarker of the outcome of rapid desensitization in penicillin allergy.Allergy. 2017; 72: 222
- Risk stratification for penicillin desensitization in allergic pregnant women with syphilis.J Allergy Clin Immunol. 2017; 139: AB31
- A new penicillin allergy diagnosis in pregnancy at Groote Schuur Hospital, Cape Town, South Africa: could this be a hormonal phenotype?.Allergy. 2017; 72: 779-781
- Penicillin desensitization: treatment of syphilis in pregnancy in penicillin-allergic patients.Ann Allergy Asthma Immunol. 2017; 118: 537-541
- Successful desensitization to penicillin after diagnostic reassessment.Allergol Immunopathol. 2003; 31: 94-96
- Penicillin skin testing in pregnant women with a history of penicillin allergy and group B streptococcus colonization.Ann Allergy Asthma Immunol. 2006; 97: 164-168
- Management of group B streptococcus in pregnant women with penicillin allergy.J Reprod Med. 2007; 52: 480-484
- Stillbirth caused by intradermal penicillin hypersensitivity test.Chin Med J (Engl). 1958; 76: 174-177
- Penicillin skin testing in pregnant women with a history of penicillin allergy.Am J Obstet Gynecol. 2017; 217: 723
- Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin.J Allergy Clin Immunol Pract. 2013; 1: 258-263
- Allergy diagnostic testing: an updated practice parameter.Ann Allergy Asthma Immunol. 2008; 121: S1-S148
- Skin testing: a survey of allergists.Ann Allergy Asthma Immunol. 2006; 96: 19-23
- Morbidity in pregnant women associated with unverified penicillin allergies, antibiotic use, and group B streptococcus infections.Perm J. 2017; 21: 16-080
- Perioperative antibiotic choice in labored versus unlabored cesareans and risk of postcesarean infectious morbidity.Am J Perinatol. 2018; 35: 127-133
Article info
Publication history
Published online: January 28, 2020
Accepted:
November 26,
2019
Received:
September 4,
2019
Footnotes
Disclosures: Conference funding for this work was supported by the Health Sciences Centre Medical Staff Executive and Rady Faculty of Health Sciences Travel Award. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
All authors have indicated that they meet the journal's requirements for authorship.
Poster presented at: Society of Obstetricians and Gynaecologists Canada 75th Annual Clinical and Scientific Conference Medical Student Program, June 11–14, 2019; Halifax, NS.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
