Only patients with a reported penicillin allergy are eligible
(ie. penicillin, amoxicillin, ampicillin)

F - Five years or less since reaction
A - Anaphylaxis or angioedema
S - Severe cutaneous adverse reaction
T - Treatment recieved for reaction (or unsure)

CALCULATED RISK:

To determine if they are appropriate for a challenge, answer the following:

Are they pregnant?
Are they using a beta blocker?
Do they have known severe heart disease (CHF, CAD, arrhythmogenic, valvular)?
Do they have any of the following respiratory diagnoses?
Do they have any of the following conditions that may confound oral challenge interpretation?

Are they safe for a challenge?

Patient is safe for oral challenge without referral to allergist. If an oral challenge is done, patient must be stable (ie. SBP>100, HR<120, using <4L O2, etc.). Settings should be equipped with antihistamines to manage mild reactions and IM epinephrine to manage anaphylactic reactions, as well as standard resuscitation medications and equipment. Please see the 'How to perform a challenge' page.

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PEN-FAST - Penicillin Allergy Risk Tool

Clinical decision rule for point-of-care risk assessment of patient-reported penicillin allergies.

Details:

A severe cutaneous adverse drug reaction includes Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS, or acute generalized exanthematous pustulosis. Acute interstitial nephritis, drug induced liver injury, serum sickness and isolated drug fever are not counted.

Risk of a positive penicillin allergy test

  • 0 points – Negligible risk of positive penicillin allergy test
  • 1-2 points – Low risk of positive penicillin allergy test 5%
  • 3 points – Moderate risk of positive penicillin allergy test 20%
  • 4-5 points – High risk of positive penicillin allergy test 50%

References

    Trubiano JA, Vogrin S, Chua KYL et al.
    Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Internal Med. Published March 16, 2020. doi:10.1001/jamainternmed.2020.0403