Management of group B Streptococcus in pregnant women with penicillin allergy.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
These results indicate that most pregnant women reporting penicillin allergy undergo negative skin tests and are able to safely receive intrapartum penicillin GBS prophylaxis.
Philipson
Elliot H
EH
Department of Obstetrics and Gynecology, Hillcrest Hospital, Cleveland Clinic Foundation, 6770 Mayfield Road, Suite 336, Mayfield Heights, OH 44124 , USA. philipe@ccf.org
Lang
David M
DM
Gordon
Steven J
SJ
Burlingame
Janet M
JM
Emery
Stephen P
SP
Arroliga
Mercedes E
ME
D000328:Adult; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D010406:Penicillins / Q000008:administration & dosage* / Q000276:immunology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000517:prevention & control; D012882:Skin Tests; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000517:prevention & control; D013292:Streptococcus agalactiae / Q000187:drug effects*
D010406:Penicillins; D007073:Immunoglobulin E