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Penicillin Skin Testing, Challenge, and Desensitization in Pregnancy: A Systematic Review

Published:January 28, 2020DOI:https://doi.org/10.1016/j.jogc.2019.11.067

      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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