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PEN-FAST–guided testing safely removes inaccurate penicillin allergy labels in hospitalized patients, supporting more appropriate antibiotic use.
A new retrospective study highlights the clinical value of the PEN-FAST decision tool in safely guiding penicillin allergy testing and de-labeling among hospitalized adults—an approach that could remarkably improve antibiotic stewardship and minimize unnecessary use of broad-spectrum agents.
Penicillin allergy is commonly recorded in patient medical histories, yet many of these labels remain unverified, limiting access to first-line antibiotics and encouraging the use of broader-spectrum alternatives. Rising evidence supports the usage of direct oral challenges in those classified as low risk using the PEN-FAST clinical decision rule, which helps clinicians identify individuals unlikely to have a true penicillin allergy.
The study assessed a pharmacist-led penicillin allergy testing protocol that incorporated the PEN-FAST decision tool, with the aim of determining de-labeling rates and evaluating the safety of allergy challenges in hospitalized patients. The analysis included individuals admitted to a 550-bed academic medical center who had a documented penicillin allergy and subsequently underwent allergy testing.
The pharmacist-led protocol included several testing approaches, such as direct oral challenges, two-step oral challenges, skin testing, intravenous (IV) challenges, and two-step IV challenges. Patient demographics, allergy histories, PEN-FAST scores, type of testing performed, test outcomes, rescue medication use within 24 hours, and subsequent updates to allergy documentation in the electronic health record were systematically collected and analyzed. The results showed that 52 hospitalized patients underwent allergy testing, with the key findings summarized in Table 1.
The most frequently performed test was the two-step oral challenge (46.2%), followed by direct oral challenge (34.6%), skin testing (15.4%), and IV or two-step IV challenges (1.9% each), as shown in Table 2:
Analysis based on PEN-FAST scores showed that no allergic reactions occurred among patients with scores of 0 or 3. Among those with scores of 1 or 2, only 1 patient (3.4%) experienced a mild reaction, presenting with dyspnea and skin eruption after getting a 10% test dose of amoxicillin; the event was managed without prominent complications.
The findings highlighted the clinical value of integrating the PEN-FAST risk assessment tool within a pharmacist-led allergy evaluation protocol for hospitalized patients. This approach enabled the safe removal of inaccurate penicillin allergy labels in a large proportion of patients while maintaining a very low rate of adverse reactions.
Open Forum Infectious Diseases
P-2015. Applying PEN-FAST in Clinical Practice: Using the PEN-FAST Decision Tool to Guide Penicillin Allergy Challenges in Hospitalized Patients
Caitlin Hart et al.
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