Cover Image

Implementing PEN-FAST for penicillin allergy delabeling in a high-prevalence population

Background and objectives Self-reported penicillin allergies lead to the use of broad-spectrum antibiotics, increase drug resistance, and constitute an economic burden. The PEN-FAST score aims to identify low-risk patients for direct drug provocation tests (DPT) without prior skin testing with a rep...

Full description

Saved in:
Bibliographic Details
Main Authors: Göcebe, Deniz (Author) , Kommoss, Katharina (Author) , Hartmann, Martin (Author) , Enk, Alexander (Author) , Schäkel, Knut (Author)
Format: Article (Journal)
Language:English
Published: January 2026
In: Journal der Deutschen Dermatologischen Gesellschaft
Year: 2026, Volume: 24, Issue: 1, Pages: 57-63
ISSN:1610-0387
DOI:10.1111/ddg.15862
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1111/ddg.15862
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.15862
Get full text
Author Notes:Deniz Göcebe, Katharina S. Kommoss, Martin Hartmann, Alexander H. Enk, Knut Schäkel
Description
Summary:Background and objectives Self-reported penicillin allergies lead to the use of broad-spectrum antibiotics, increase drug resistance, and constitute an economic burden. The PEN-FAST score aims to identify low-risk patients for direct drug provocation tests (DPT) without prior skin testing with a reported negative predictive value (NPV) of over 95%. Patients and methods In this single-center study (Department of Dermatology, University Hospital Heidelberg, Germany), the PEN-FAST score was evaluated for patients carrying a penicillin allergy label between 2004 and 2024. Skin testing, allergen-specific IgE, and consecutive DPT were performed. Results A total of 189 patients were analyzed. In a retrospective cohort, 106 of 149 patients showed negative skin tests and received DPT, leading to the delabeling of 99 patients (66.4%). PEN-FAST identified 55 of 149 (36.9%) as low-risk, of which three low-risk patients were misclassified. In a prospective PEN-FAST low-risk cohort, one of 40 patients showed a mild reaction after DPT. Overall, NPVs of both PEN-FAST and formal allergy testing were 95.8%. Conclusions Our results advocate for direct DPT in patients carrying a penicillin allergy label classified as low-risk by PEN-FAST. PEN-FAST demonstrated high NPV, safety, and feasibility in a cohort with a high prevalence of true allergies.
Item Description:Veröffentlicht: 14 September 2025
Gesehen am 16.01.2026
Physical Description:Online Resource
ISSN:1610-0387
DOI:10.1111/ddg.15862

Similar Items