Direct Challenge Safe for Penicillin Allergy in Pregnancy

TOPLINE:

In low-risk pregnant women with penicillin allergy, direct challenges with amoxicillin were as safe as penicillin skin testing while offering shorter completion times at a lower cost.

METHODOLOGY:

• Researchers conducted a randomized trial that included 144 pregnant women (median age, 29 years) who were referred to the Rochester Regional Health allergy/immunology practice for routine penicillin allergy evaluation from April 2022 through September 2024.
• Patients were randomly assigned to undergo penicillin skin testing or a direct challenge.
• For the direct challenge, patients received oral amoxicillin 40 mg and were monitored for 30 minutes. If they did not react to this initial dose, they received 400 mg and were monitored for 30 minutes more.

TAKEAWAY:

• Overall, 93.2% of women who underwent penicillin skin testing had a negative evaluation for penicillin allergy compared with 100% of women who underwent direct challenge.
• Direct challenges had a median completion time of 65 minutes and cost $422.61 each, whereas penicillin skin tests took a median of 75 minutes and cost $685.36 each.
• No participants in either group required medical treatment or epinephrine for reactions.
• Hospital length of stay postdelivery was not significantly different between the groups.

IN PRACTICE:

“Although patients and healthcare professionals may be concerned about the risk of an adverse reaction with a [penicillin] allergy evaluation in pregnancy, particularly a [direct challenge], our study supports the safety of this approach in pregnant women in all trimesters,” the authors of the study wrote.

SOURCE:

Sara Patrawala, MD, with the University of Rochester School of Medicine and Dentistry, Rochester, New York, was the corresponding author of the study, which was published online on July 9 in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

The study had a relatively small sample size and was conducted at a single site.

DISCLOSURES:

Two authors reported serving on speakers bureaus for pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.