BC Women’s Hospital Allergy Clinic Team

Penicillin allergies can present a significant concern, in particular for those who are pregnant. About half of all pregnant people will require an antibiotic during pregnancy and 10% of those will report an allergy to penicillin. The presence of a penicillin allergy label leads to the use of second-line agents, which in turn can increase the risk of postpartum infections, complications in postoperative caesarean wounds, and prolonged hospital stays. Additionally, newborns of mothers with penicillin allergies may undergo increased medical interventions, such as blood draws and extended hospitalizations.

Recognizing the critical need for a solution, the BC Women’s Penicillin Allergy Delabelling Clinic was established as the first dedicated Canadian centre to offer penicillin allergy testing specifically tailored to pregnant individuals. The clinic uses a risk-based algorithm and directly offers antibiotic challenges to determine if the allergy is accurate.  Spearheaded by a collaborative effort between the Department of Obstetrics and Gynecology, the Department of Allergy and Immunology and BC Women’s Hospital and Health Centre, the clinic’s team is multidisciplinary and currently includes Dr. Chelsea Elwood, Dr. Julie van Schalkwyk, Dr. Jeffrey Wong, Dr. Raymond Mak, Dr. Stephanie Erdle, Dr. Ryan Lo, nursing lead Alyssa Stewart, pharmacist lead Dr. Vanessa Paquette and clerk Jacqueline Millard. Since its inception, the clinic has successfully helped 800 pregnant individuals have their allergies tested and the penicillin allergy removed.  This will directly impact their current pregnancy and delivery, future pregnancies and their entire lives moving forward through health care. Dr Raymond Mak shared “I have worked at a lot of clinics in the past and this is the most efficient, flexible clinic ever. There is a strong culture of improvement. When we notice a problem, we think of a solution and changes happen.”

A cornerstone of the initiative’s success lies in its commitment to rigorous tracking and monitoring of patient encounters. This meticulous approach has not only facilitated safe and effective delabelling but has also instilled confidence in patients and health care providers alike and is actively removing the fears around allergy testing for anyone. “I absolutely love my team and the care we provide! Patients are so excited to get their allergy tested and leave feeling at ease and reassured,” commented Alyssa Stewart, nursing lead with the clinic.

Beyond individual patient care, the initiative has made notable contributions to advancing clinical practice. Multiple publications stemming from the clinic’s work have established penicillin allergy delabelling as the standard of care in pregnancy, garnering recognition from prestigious organizations such as the American Academy of Allergy, Asthma & Immunology.  The creation of a de-labelling tool in the First Line app has allowed access to testing across the province. Quantitative data further supports the initiative’s impact, with cost-effectiveness analyses revealing substantial lifetime cost savings per patient of more than $57, 000 per patient and about $44 million to the health system overall.

In its ongoing commitment to knowledge dissemination, the initiative’s team is poised to present their findings at the upcoming Infectious Diseases Society for Obstetrics and Gynecology conference, further solidifying its position at the forefront of perinatal allergy assessment. This recognition extends to the local level, with accolades from UBC’s Department of Obstetrics & Gynaecology Academic Day, affirming the initiative’s excellence.

The ripple effects of the BC Women’s Penicillin Allergy Delabelling Clinic’s success extend far beyond its immediate reach. Inspired by its pioneering model, the University of Manitoba has established its own penicillin allergy delabelling clinic, signalling a broader movement towards equitable access to quality care for pregnant individuals nationwide.  Locally the team has supported Lions Gate hospital and Prince George to offer testing to their pregnant persons. Looking ahead, the initiative aims to empower clinicians in community hospitals across British Columbia to establish similar programs, ensuring that all pregnant individuals have access to the highest standards of care, regardless of geographical location.