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Drug Allergy: An updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259-273.e278
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•• Wolfson AR, Mancini CM, Banerji A, et al. Penicillin allergy assessment in pregnancy: safety and impact on antibiotic use. J Allergy Clin Immunol Pract. 2021;9(3):1338–46. This paper describes an approach to triage of pregnant patients with listed penicillin allergies which uses e-consults to address some logistical barriers, but still almost 40% of patients did not keep their penicillin skin testing appointments. In the paper, the antibiotic outcomes between the group triaged for eligibility for skin testing vs those who did undergo skin testing were compared, and the patients who had been successfully de-labeled had a statistically significant improved likelihood of receiving first-line beta-lactams for GBS and C-section prophylaxis.
Plager JH, Mancini CM, Fu X, et al. Preoperative penicillin allergy testing in patients undergoing cardiac surgery. Ann Allergy Asthma Immunol. 2020;124(6):583–8.
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• Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of penicillin allergy: a review. JAMA. 2019;321(2):188–99. This is a useful, succinct overview of the approach to the pregnant patient with a listed penicillin allergy.
Banks TA, Tucker M, Macy E. Evaluating penicillin allergies without skin testing. Curr Allergy Asthma Rep. 2019;19(5):27.
Mustafa SS, Conn K, Ramsey A. Comparing direct challenge to penicillin skin testing for the outpatient evaluation of penicillin allergy: a randomized controlled trial. J Allergy Clin Immunol Pract. 2019;7(7):2163–70.
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Mak R, Yuan Zhang B, Paquette V, et al. Safety of direct oral challenge to amoxicillin in pregnant patients at a Canadian tertiary hospital. J Allergy Clin Immunol Pract. 2022;10(7):1919-1921.e1911.
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Wu SS, Abraham T, Michaud C, et al. Fetal response to intramuscular epinephrine for anaphylaxis during maternal penicillin desensitization for secondary syphilis. J Matern Fetal Neonatal Med. 2018;31(16):2223–5.
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Desravines N, Waldron J, Venkatesh KK, Kwan M, Boggess KA. Outpatient penicillin allergy testing in pregnant women who report an allergy. Obstet Gynecol. 2021;137(1):56–61.
Patel V, Gleeson PK, Delaney K, Ralston SJ, Feldman S, Fadugba O. Safety and outcomes of penicillin allergy evaluation in pregnant women. Ann Allergy Asthma Immunol. 2022;128(5):568–74.
•• Kwah JH, Burn MS, Liao J, Cate J, Son M. Outpatient penicillin allergy evaluation during pregnancy and associated clinical outcomes. Am J Obstet Gynecol MFM. 2022;4(5):100674. The authors used a history-based triage tool to risk-stratify patients and then gave low risk pregnant patients a "direct oral challenge" of penicillin without preceding skin test. With only 4 of 207 patients having delayed maculopapular rashes, this approach appears promising.
Gill MM, Gasner S, Banken A, et al. Improving routine prenatal penicillin allergy testing for reported penicillin allergy. BMJ Open Qual. 2022;11(3).
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