The following is a summary of “Safety and savings from penicillin allergy de-labeling in pregnancy: good stewardship, good cents,” published in the FEBRUARY 2023 issue of Obstetrics and Gynecology by Atkinson A, et al.

Studies have found that a large percentage of pregnant women who reported a penicillin allergy could be safely de-labeled, with only a small number of them having a true penicillin allergy. However, a penicillin allergy label can lead to inappropriate antibiotic prescribing, increased healthcare costs, and poor obstetric outcomes. For a study, researchers sought to evaluate the safety of penicillin de-labeling during pregnancy and calculate potential lifetime cost savings resulting from de-labeling.

The study followed 208 pregnant patients who underwent penicillin de-labeling through a de-labeling algorithm, skin testing, and direct oral challenge. The results were compared to a control group of patients referred to the clinic but did not receive de-labeling. Maternal and neonatal outcomes were evaluated. Healthcare cost modeling was performed based on the lifetime cost of a penicillin allergy label versus the cost after de-labeling in pregnancy, considering variables such as the number of appropriate prescriptions per episode of infection.

The study found that 100% of de-labeled patients who required Group B Streptococcus prophylaxis safely received penicillin during labor, while only 6.7% of the control group did so. Furthermore, 97.7% of de-labeled patients who required cesarean section prophylaxis safely received cefazolin, compared to 90.6% of the control group. There was no significant difference in maternal or neonatal outcomes between the de-labeled and control groups. Based on cost savings estimated at $1,947 per episode of postpartum infection after de-labeling, the potential life saving per patient was $58,780.

In conclusion, the study demonstrated that penicillin allergy de-labeling during pregnancy benefits individual patients and healthcare systems. The cost analysis showed that there are significant cost savings associated with de-labeling. The findings of the study suggested that there was a need for further education and advocacy for penicillin allergy de-labeling during pregnancy, as it was a unique time for health optimization with immediate and long-lasting benefits.

Reference: ajog.org/article/S0002-9378(22)00995-4/fulltext