New Clinical Decision Tool Allows Many Patients to Skip Penicillin Skin Testing

Fewer than 10% of patients labeled as penicillin allergic in North America truly have penicillin allergies. A new clinical decision tool adds to recent studies that show primary care doctors can delabel patients safely without skin testing (NEJM JW Gen Med Oct 15 2019 and J Allergy Clin Immunol Pract 2019; 7:2163).

To validate this decision aid, 945 adults who were labeled as penicillin allergic underwent a combination of skin testing and oral challenges. About 9% of patients tested positive; positive tests could be predicted using the mnemonic PEN-FAST, which involves the following:

• Allergy event occurred Five or fewer years ago (2 points)

• Anaphylaxis/angioedema or Severe cutaneous adverse reaction (2 points)

• Treatment required for allergy epi…