Drug allergies, specifically antibiotic allergies, are frequently encountered in obstetrics and gynecology as10% of the United States population reports a penicillin allergy. This poses a particular challenge to the obstetrician-gynecologist as beta-lactam antibiotics are indicated as first-line therapy for the treatment and prevention of most specialty-specific infections. Alternative antibiotic use in the setting of a reported allergy, is not benign and has been associated with increased cesarean delivery, endometritis, wound complications, and increased lengths of hospital stay in pregnant patients, increased Group B Streptococcus sepsis, neonatal length of stay and neonatal lab draws in neonates born to allergic patients and increased surgical site infections in gynecologic patients. Furthermore, alternative antibiotic use leads to increased antibiotic resistance, toxicity and healthcare cost. . Administration of antibiotics in a patient with a history of a Type I immediate hypersensitivity reaction, however, poses the risk of anaphylaxis with repeat exposure. Fortunately, over 90% of patients who report a penicillin allergy are not truly allergic and would tolerate penicillins if administered. This can be due to either mislabeling of the index reaction as an allergy (when it was due to a drug intolerance or a viral exanthem) or due to waning Immunoglobulin E-mediated immunity over time. Given this, allergy evaluation is widely recommended, even in pregnancy. Allergy evaluation involves a detailed patient history and when appropriate allergy testing with skin testing and/or oral challenge. These tools when used appropriately have been found to be safe and effective in gravid as well as non-gravid individuals and result in increased use of first line antibiotics. Furthermore, even in the setting of a true penicillin allergy, cross-reactivity with cephalosporins is extremely low and estimated at 2-3% among patients with a verified penicillin allergy and significantly lower than this among patients with an unverified penicillin allergy. Guidelines support routine use of cephalosporins without testing or additional precautions in patients with an unverified nonanaphylactic penicillin allergy as well as routine use of structurally dissimilar cephalosporins (specifically ancef) even in patients with an anaphylactic penicillin allergy. In cases where there is no appropriate alternative antibiotic than to the one which the patient is allergic such as with syphilis in a penicillin allergic pregnant patient, desensitization can be performed. This process involves temporary induction of drug tolerance through exposure of small amounts of the allergen until a therapeutic dose is achieved and has been safely performed in pregnancy. Desensitization requires expert supervision and is most often performed in the intensive care setting with a multidisciplinary team. The other two most common antibiotic allergies encountered in obstetrics and gynecology are to cephalosporins and metronidazole. Cephalosporin allergies are managed similarly to penicillin allergies with readily available skin testing and oral challenge. Skin testing for metronidazole allergy lacks sensitivity and specificity and thus oral challenge or desensitization procedure is the preferred approach for low risk and high-risk patients respectively. When it comes to drug allergies, and specifically antibiotic allergies, the role of the obstetrician-gynecologist is to identify patients with a reported allergy and to refer patients to a specialist for further evaluation as soon as possible. Allergy evaluation by means of a detailed patient history and allergy testing (skin testing and/or oral challenge) when indicated has been shown to be safe and effective and is an important part of antibiotic stewardship.

中文翻译：

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妇产科药物过敏的诊断和临床管理：专家评价。


药物过敏，特别是抗生素过敏，在妇产科中经常遇到，因为 10% 的美国人口报告对青霉素过敏。这对妇产科医生提出了特殊的挑战，因为 β-内酰胺类抗生素被指示作为治疗和预防大多数专业特异性感染的一线疗法。在报告过敏的情况下使用替代抗生素不是良性的，并且与剖宫产、子宫内膜炎、伤口并发症和孕妇住院时间增加、B 组链球菌败血症增加、新生儿住院时间和新生儿实验室吸引过敏患者所生新生儿和妇科患者手术部位感染增加有关。此外，替代抗生素的使用会导致抗生素耐药性、毒性和医疗保健成本增加。.然而，对有 I 型速发型超敏反应史的患者使用抗生素，重复暴露会带来过敏反应的风险。幸运的是，超过 90% 报告青霉素过敏的患者并不是真正的过敏，如果服用青霉素，他们会耐受青霉素。这可能是由于将指示反应错误地标记为过敏（当它是由于药物不耐受或病毒疹时）或由于免疫球蛋白 E 介导的免疫力随着时间的推移而减弱。鉴于此，广泛推荐进行过敏评估，即使在怀孕期间也是如此。过敏评估包括详细的患者病史，并在适当时进行过敏测试，包括皮肤试验和/或口服激发试验。已发现这些工具如果使用得当，对孕妇和非孕妇都是安全有效的，并导致一线抗生素的使用增加。 此外，即使在真正的青霉素过敏的情况下，与头孢菌素的交叉反应性也极低，在经证实的青霉素过敏患者中估计为 2-3%，而在未经证实的青霉素过敏患者中明显低于此水平。指南支持对未经证实的非过敏性青霉素过敏患者常规使用头孢菌素类药物，无需检查或采取额外预防措施，以及常规使用结构不同的头孢菌素类（特别是 ANCEF），即使是对过敏性青霉素过敏的患者也是如此。在没有合适的替代抗生素替代患者过敏抗生素的情况下，例如青霉素过敏孕妇的梅毒，可以进行脱敏。这个过程包括通过暴露少量过敏原来暂时诱导药物耐受性，直到达到治疗剂量并在怀孕期间安全进行。脱敏需要专家监督，最常在重症监护病房由多学科团队进行。妇产科中遇到的另外两种最常见的抗生素过敏是对头孢菌素和甲硝唑过敏。头孢菌素过敏的管理与青霉素过敏类似，需要现成的皮肤试验和口腔激发试验。甲硝唑过敏的皮肤试验缺乏敏感性和特异性，因此口服激发试验或脱敏手术分别是低风险和高风险患者的首选方法。 当涉及到药物过敏，特别是抗生素过敏时，妇产科医生的作用是识别有过敏报告的患者，并尽快将患者转诊给专科医生进行进一步评估。通过详细的患者病史和过敏试验（皮肤试验和/或口服激发试验）进行过敏评估已被证明是安全有效的，并且是抗生素管理的重要组成部分。