The Case for Delabeling NNAALs in Obstetric Care, With Chang Su, MD

Non-narcotic analgesics allergy labels (NNAAL) significantly elevated rates of eclampsia (aRR, 1.5; 95% CI, 1.06–2.12), preterm birth (aRR, 1.21; 95% CI, 1.14–1.28), NICU admission (aRR, 1.17; 95% CI, 1.10–1.25), and neonatal withdrawal syndrome (aRR, 1.51; 95% CI, 1.24–1.84) among labeled mothers across 2,244,210 California singleton livebirths — point toward a clear intervention target: the family planning stage, before pregnancy makes formal drug challenge testing contraindicated.1,2

At the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting held in Philadelphia, Pennsylvania, from February 27 to March 2, Chang Su, MD, allergist-immunologist at Yale New Haven Hospital outlined why timing matters enormously for NNAAL de-labeling efforts. Evaluating a prior ibuprofen reaction, for example, ideally requires a provocation challenge — which is contraindicated during pregnancy. Waiting until a patient is already pregnant to initiate drug allergy evaluation therefore forecloses the most definitive diagnostic pathway. Su's preferred model is pre-conception referral, integrated into routine family planning screening by OB-GYN and cardiology colleagues, so that allergy status is clarified before it becomes clinically urgent. She described active efforts to work NSAID allergy screening into standard documentation templates and electronic health record workflows used by APPs and physicians in OB practices at her institution — a structural intervention designed to normalize proactive referral rather than relying on reactive, crisis-driven evaluation.

Su also used the final portion of the conversation to reframe how the field should think about drug allergy labels more broadly. NNAALs affect approximately 2% of the population — rarer than beta-lactam labels, which appear in roughly 10% of charts, and therefore harder to study at scale. The study does not overturn existing paradigms around allergy labeling, Su acknowledged, but it extends the known harms of inappropriate labels from beta-lactams into the NSAID class, and makes it easier to extrapolate that other inaccurate allergy labels likely carry similar outcome consequences. Her broader call to action was cultural as much as clinical: rather than entering a blank medication allergy into the chart, clinicians should document the specific reaction type, severity, and any confirmed tolerability thresholds — information that allows downstream providers to make nuanced decisions rather than defaulting to broad avoidance. As Su put it, allergy labels are not a single entity, and the field is increasingly recognizing that indiscriminate labeling carries real repercussions, particularly when it walls patients off from first-line therapies tied to the best outcomes.

Su has no relevant disclosures to report.

References

1. Su C, Baer R, Otani I, Schatz M, Chambers C. The relationship between maternal non-narcotic analgesics allergy labels and maternal and fetal outcomes: results from a large, administrative cohort. Presented at: AAAAI 2026 Annual Meeting, February 27-March 2, Philadelphia, Pennsylvania. Abstract #L24

2. Non-Narcotic Analgesics Allergy Labels Linked to Adverse Maternal and Fetal Outcomes. News release. AAAAI. February 26, 2026. https://www.aaaai.org/about/news/news/2026/narcotic