Management of group B Streptococcus in pregnant women with penicillin allergy

• Published in: Journal of reproductive medicine Vol. 52; no. 6; p. 480
• Main Authors: Philipson, Elliot H, Lang, David M, Gordon, Steven J, Burlingame, Janet M, Emery, Stephen P, Arroliga, Mercedes E
• Format: Journal Article
• Language: English
• Published: United States 01.06.2007
• Subjects: Adult; Drug Hypersensitivity - diagnosis; Female; Humans; Immunoglobulin E - immunology; Infectious Disease Transmission, Vertical - prevention & control; Penicillins - administration & dosage; Penicillins - immunology; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - prevention & control; Skin Tests; Streptococcal Infections - drug therapy; Streptococcal Infections - prevention & control; Streptococcus agalactiae - drug effects
• ISSN: 0024-7758

To determine whether group B Streptococcus (GBS)-colonized pregnant women who report a history of penicillin allergy can safely undergo diagnostic evaluation to rule out or confirm the potential for an IgE-mediated (allergic) reaction to penicillin. Over 18 months, all pregnant women with GBS-positive vaginal/rectal cultures and a history of penicillin allergy were referred to the Department of Allergy and Immunology for a history and possible skin testing. Patients who had experienced anaphylaxis were advised to continue avoiding penicillin and were not skin tested. Women without such a history underwent immediate hypersensitivity (percutaneous and intradermal) testing using 2 penicillin reagents with controls. If skin testing was negative, intrapartum antimicrobial prophylaxis with intravenous penicillin was administered. Of 28 patients with both GBS colonization and "penicillin allergy," 25 (89%) had negative skin testing to penicillin and received intrapartum penicillin for GBS prophylaxis without adverse reactions. Skin testing was positive in 2 patients, and intrapartum penicillin was not administered. Penicillin skin testing was not performed on 1 patient due to a history of anaphylaxis from penicillin. These results indicate that most pregnant women reporting penicillin allergy undergo negative skin tests and are able to safely receive intrapartum penicillin GBS prophylaxis.