Penicillin skin testing in pregnant women with a history of penicillin allergy and group B streptococcus colonization

Abstract

Background: The safety and utility of penicillin skin testing (PST) in pregnant women with a history of penicillin allergy and group B streptococcus (GBS) colonization have not been studied.

Objective: To document the safety and utility of PST in pregnant women with a history of penicillin allergy and GBS colonization.

Methods: Pregnant GBS culture-positive women with a history compatible with an IgE-mediated or unknown reaction to a penicillin-class antibiotic were recruited for PST. If PST results were negative, penicillin-class antibiotics were recommended for GBS prophylaxis. Adverse reactions associated with PST or antibiotic use from the time of PST through delivery and 6 months post partum were reported.

Results: In 56 enrolled patients, there were only 2 mild adverse reactions (4%) associated with PST and 3 positive PST results (5%). Of the 53 PST-negative patients, 47 (89%) received at least 1 course of penicillin. There were 2 delayed-onset rashes associated with the use of intrapartum penicillins and 1 immediate-onset rash with intrapartum vancomycin therapy in a PST-positive woman. There were 7 reactions (6%) associated with 122 antibiotic courses administered.

Conclusions: Penicillin skin testing can be performed safelyin pregnant women and, if the results are negative, allows penicillins to be used safely at delivery for GBS prophylaxis.