Introduction: Approximately 10% of individuals report a suspected allergy to penicillin, but according to allergy work-ups, only 10%-15% of them are truly allergic. A clinical decision score, the PEN-FAST, was developed and validated to identify adults with low-risk penicillin allergy.
Objectives: The objective of this study was to improve the performance of the PEN-FAST score, particularly for those with delayed hypersensitivity (HS), by improving the negative predictive value.
Methods: STEP 1: Retrospective evaluation of the PEN-FAST score in patients with proven immediate and delayed penicillin allergy. STEP 2: Identification of additional criteria among Step 1 patients misclassified by PEN-FAST score. Development of the PEN-FAST+ score using multivariable logistic regression in a prospective cohort of patients with a suspicion of HS to penicillin. STEP 3: Comparison of diagnostic performances of PEN-FAST and PEN-FAST+ scores.
Results: The PEN-FAST score showed limitations in predicting the relapse of immediate skin HS or delayed maculopapular exanthema, with 28.6% and 38.4% of patients misclassified, respectively. We identified two potential additional criteria: skin rash lasting more than 7 days and immediate reaction occurring in less than 1 h (generalized or localized on palmoplantar area or scalp itching/heat feeling). A total of 32/252 (12.7%) patients were confirmed to be allergic to penicillin. With PEN-FAST, 37% of patients ( = 10) with delayed allergic penicillin HS were misclassified. With PEN-FAST+, 3 patients with delayed HS confirmed by a ST (11.1%) were misclassified. The AUC was significantly higher for PEN-FAST+ than PEN-FAST (85% vs. 72%, = 0.03).
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| http://dx.doi.org/10.3389/falgy.2023.1302567 | DOI Listing |
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PEN-FAST-ED: Utilizing the PEN-FAST decision tool to guide antibiotic prescribing in the emergency department.
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July 2024
Allergology Unit, Departement of Dermatology, University Hospital, Besançon, France.
Article Synopsis
- The study evaluated the effectiveness of the PEN-FAST decision score for identifying true penicillin allergies in a group of 214 patients, including both adults and children.
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IDESP (The Desbrest Institute of Epidemiology and Public Health), University of Montpellier-INSERM (National Institute of Health and Medical Research), Montpellier, France; Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.
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Klinik für Anästhesiologie, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
The beta-lactam antibiotics are some of the safest and best-tolerated antibiotic agents; however, many patients have reported allergies against penicillin. All beta-lactam antibiotics are only restrictively prescribed for these patients and alternative antibiotics are increasingly given, which carries the risk of negative clinical results and socioeconomic sequelae; however, over 95% of patients who reported an allergy to penicillin show a negative result in the allergy tests for penicillin and this antibiotic can safely be prescribed. The use of sensitive and specific instruments for identification of false penicillin allergies should be an important topic within the framework of antibiotic stewardship.
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