TOPLINE:

In pregnant women with penicillin allergy, testing increased beta‑lactam antibiotic usage and was associated with fewer cesarean deliveries, shorter neonatal hospital stays, and lower neonatal sepsis scores compared with no testing.

METHODOLOGY:

• Researchers assessed pregnant women with penicillin allergy to determine whether prenatal penicillin allergy testing alters antibiotic use and maternal and neonatal outcomes compared with usual care.
• A total of 45 participants with penicillin allergy (mean age, 31.1 years) underwent penicillin allergy testing, followed by an oral amoxicillin drug challenge; 105 participants with penicillin allergy (mean age, 28.9 years) who did not undergo testing served as the usual care group.

TAKEAWAY:

• Overall, 96% in the tested group received beta-lactam antibiotics, whereas 38% in the usual care group did so; 65% in the penicillin testing group received penicillin, whereas 7% in the usual care group did so (P < .001 for both).
• Participants in the tested group had 69% lower odds of cesarean delivery than those in the usual care group (adjusted odds ratio [aOR], 0.31; 95% CI, 0.13-0.72); however, they had higher odds of requiring group B streptococcus prophylaxis (aOR, 2.75; 95% CI, 1.17-6.48).
• Infants born to mothers in the tested group had 69% lower mean length of hospital stay than those born to mothers in the usual care group (aOR, 0.31; 95% CI, 0.18-0.55).
• Neonates born to mothers in the tested group had 59% lower odds of high neonatal sepsis scores than those born to mothers in the usual care group (aOR, 0.41; 95% CI, 0.19-0.86).

IN PRACTICE:

"Our study supports the enhancement of antibiotic options not only during peripartum but also in antepartum with proactive PCN [penicillin] allergy evaluation," the authors wrote.

SOURCE:

Mildred Kwan, MD, PhD , with the University of North Carolina School of Medicine at Chapel Hill, was the corresponding author of the study, which was published online on April 15, 2026, in The Journal of Allergy and Clinical Immunology: Global.

LIMITATIONS:

The study was limited by its small sample size and single‑center design, with allergy evaluations interrupted by early COVID‑19 clinic closures. Higher private insurance rates in the tested cohort and the allergy clinic's remote location may have introduced socioeconomic and selection bias. Most participants had low‑risk allergy histories, which may have restricted the applicability of the findings to patients with moderate‑to‑high risk.

DISCLOSURES:

This study was funded by the Cefalo-Bowes grant and internal support from the Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, at the University of North Carolina at Chapel Hill, and the university's Department of Internal Medicine, Division of Allergy and Immunology. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.