Skin testing and oral amoxicillin challenge in the outpatient allergy and clinical immunology clinic in pregnant women with penicillin allergy.

BACKGROUND: Penicillin allergy is frequently reported. In pregnant women, reported penicillin allergy is associated with negative health outcomes and suboptimal group B streptococcal prophylaxis. For individuals having penicillin allergy, skin testing followed by an observed oral challenge is recommended. Previous data indicate a low risk of adverse reaction with skin testing in pregnant women, but the subsequent oral challenge was not routinely pursued. OBJECTIVE: To determine whether skin testing followed by the outpatient oral challenge is tolerated by pregnant women. METHODS: We conducted a retrospective review of all pregnant women who underwent penicillin allergy evaluation at an outpatient allergy and clinical immunology clinic. The patients underwent oral amoxicillin challenges based on the discretion of the allergy provider. We evaluated the index reaction history, skin test results, oral challenge results, and subsequent antibiotic exposure. RESULTS: A total of 46 pregnant women underwent skin testing without adverse reactions, of whom 44 patients (95.6%) received negative results. A total of 18 women (39%) completed an oral challenge without adverse reactions. Patients challenged vs not challenged did not differ in patient age, gestational age, latency since index reaction, or reaction history risk level. Notably, 28 women received intrapartum antibiotics. There was no difference in intrapartum antibiotic administration between those who did or who did not complete an in-office oral challenge (P = .90). CONCLUSION: Penicillin skin testing and oral challenge in pregnant women can safely be performed in the outpatient setting. There was no difference in the intrapartum antibiotic use between women who were and those who were not challenged. Further research is needed to determine the utility of oral challenge in pregnant patients.

Patterns of North American Women Authorship in 2 Allergy/Immunology Journals: 1997-2017.

BACKGROUND: Disparities in the frequency of publications by gender have been reported in various medical subspecialties. OBJECTIVE: Review author gender in the Journal of Allergy and Clinical Immunology and Annals of Allergy, Asthma and Immunology from 1997 to 2017. METHODS: Data on frequency and patterns of authorship by gender were collected in 5-year intervals and analyzed by journal, article type, and year of publication. Logistic regression was used to analyze factors associated with a greater likelihood of first authors being women. We compared these patterns with the frequency of women AAAAI (American Academy of Allergy, Asthma & Immunology) members and AAAAI fellows-in-training. RESULTS: Women were first authors in 36.5% of publications, increasing from 26.6% in 1997 to 48.1% in 2017 (P < .001). Their share as first author was highest (42.5%) for original articles and lowest (17.1%) for editorials. Share of women as last authors increased from 18.1% in 1997 to 30.9% in 2017 (P = .001). Women were less likely to be sole authors: 17.7% (P < .001). Articles with women as first authors were observed more frequently when women were last authors (odds ratio [OR], 3.14; P < .0001). This association was more likely in original investigations (OR, 2.1; P < .001) and articles published more recently (2007, 2012, 2017) (OR, 1.75; P < .001). The increasing rate of women first authors correlated with rising proportions of women AAAAI members (Pearson correlation = 0.96; P = .01) and fellows-in-training (Pearson correlation = 0.96; P < .01). CONCLUSIONS: Women authorship has become more frequent in the Journal of Allergy and Clinical Immunology and Annals of Allergy, Asthma and Immunology. The probability of women being first authors is more likely in articles with women as last authors, implying that mentorship of women by women may encourage women to become more active in scholarship.