A Randomized Trial Comparing Direct Challenges to Penicillin Skin Testing for Outpatient Low-Risk Penicillin Allergy Evaluations in Pregnancy

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-09-01 DOI:10.1016/j.jaip.2025.07.003

Sara Patrawala MD , S. Shahzad Mustafa MD , Richard Kraude PhD , Allison Ramsey MD

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Abstract

Background

The importance of penicillin allergy de-labeling in the general population is well known. Its significance is further highlighted in pregnancy because penicillin-based antibiotics are first-line therapy for most infections at the time of delivery, particularly group B Streptococcus.

Objective

To evaluate the safety of a two-step direct challenge (DC) to amoxicillin without preceding skin testing in pregnant patients with a low-risk penicillin allergy label, regardless of trimester.

Methods

We performed a prospective, randomized controlled trial comparing penicillin skin testing (PST) followed by an oral amoxicillin challenge versus a two-step DC to amoxicillin without preceding skin testing in pregnant patients regardless of trimester with a low-risk penicillin allergy label.

Results

A total of 144 women were included in this study, 73 of whom underwent PST and 70 of whom underwent DC. Of those women, 68 (93.2%) undergoing PST had a negative evaluation for penicillin allergy compared with 70 (100%) who underwent DC. No reactions in either PST or DC groups required medical treatment or, notably, administration of epinephrine. Direct challenge took significantly less time compared with PST. Median time for PST was 75 minutes (interquartile range, 75-80 minutes) compared with 65 minutes (interquartile range, 65-70 minutes) for DCs.

Conclusion

For evaluation of penicillin allergy in pregnancy, we demonstrate that a DC is as safe as PST in low-risk pregnant patients.

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一项随机试验比较直接挑战青霉素皮肤试验在门诊低风险青霉素过敏评估妊娠。

背景：青霉素过敏去标签在普通人群中的重要性是众所周知的。它的重要性在妊娠期间甚至更加突出，因为青霉素类抗生素是分娩期间或分娩时大多数感染的一线治疗方法，特别是B族链球菌。目的：评估两步直接给药阿莫西林的安全性，无需事先皮肤试验的孕妇低风险青霉素过敏标签，无论妊娠三个月。方法：我们进行了一项前瞻性随机对照试验，比较青霉素皮肤试验（PST）后口服阿莫西林刺激与2步直接刺激（DC）阿莫西林没有事先皮肤试验的孕妇，无论妊娠期是否有低风险青霉素过敏标签。结果：144名女性参与了这项研究。73例行PST， 70例行DC。68名（93.2%）接受PST的女性对青霉素过敏的评价为阴性，而70名（100%）接受DC的女性对青霉素过敏的评价为阴性。在PST组和DC组中都没有需要药物治疗的反应，或者值得注意的是，给药肾上腺素。与PST相比，DC所需的时间明显更短，PST的中位时间为75 [IQR 75,80]分钟，而DC的中位时间为65 [IQR 65, 70]分钟。结论：对于妊娠期青霉素过敏的评估，我们证明在低危妊娠患者中，DC与PST一样安全。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.