_id

683a164cc782e11e38d1b31f

id

10422

title

Penicillin Allergy Decision Rule (PEN-FAST)

full_title

Penicillin Allergy Decision Rule (PEN-FAST)

short_title

PEN-FAST

med_description

Identifies low-risk penicillin allergies.

short_description

Penicillin allergy identification.

slug

penicillin-allergy-decision-rule-pen-fast

description

The Penicillin Allergy Decision Rule (PEN-FAST) identifies low-risk penicillin allergies.

keywords

Penicillin Allergy Decision Rule (PEN-FAST), pen-fast, penicillin, penicillin allergy, allergy, penicillin allergy rule, allergy to penicillin

complaint

[ "Diarrhea", "Fatigue", "Fever", "Joint Pain", "Nausea", "Rash", "Seizure", "Shortness of Breath", "Swelling", "Vomiting", "Wheezing" ]

formula

The PEN-FAST Score is calculated by the addition of the selected points:

evidence

measurements

[]

information

Interpretation:

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/32176248/", "text": "Trubiano JA, Vogrin S, Chua KYL, et al. Development and validation of a penicillin allergy clinical decision rule. JAMA Intern Med. 2020;180(5):745-752." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/34271183/", "text": "Piotin A, Godet J, Trubiano JA, et al. Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule. Ann Allergy Asthma Immunol. 2022;128(1):27-32." } ], "Validations": [] }

pearls

• This tool has a high negative predictive value (NPV of 96.3% for scores <3), making it effective for ruling out penicillin allergy in low-risk cases.
• Severe cutaneous reactions may include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis.

usecase

Indicated for patients with a reported penicillin allergy to assess allergy risk, especially when considering penicillin or related β-lactam therapy.

reasons

Identifies low-risk penicillin allergies that do not require formal skin testing. Its use at the point of care can help reduce unnecessary penicillin avoidance in low-risk patients, minimizing the need for broad-spectrum antibiotic alternatives.

next_advice

• Low-risk (score <3): Consider a direct oral or graded challenge.
• Moderate- to high-risk (score ≥3): Refer to an allergist for a more detailed evaluation, which may include skin testing.
• Document the PEN-FAST score and any subsequent allergy testing results in the medical record to support future clinical decisions.

next_actions

next_management

diseases

[ "Allergy" ]

input_schema

[ { "conditionality": null, "default": 0, "label_en": "<p><span style=\"text-decoration: underline;\"><strong>F</strong></span>ive years or less since reaction</p>", "md_calc_info_concept": null, "name": "f", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes/unknown", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "<p><span style=\"text-decoration: underline;\"><strong>A</strong></span>naphylaxis or angioedema</p>\n<p>OR</p>\n<p><span style=\"text-decoration: underline;\"><strong>S</strong></span>evere cutaneous adverse reaction</p>", "md_calc_info_concept": null, "name": "as", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "<p><span style=\"text-decoration: underline;\"><strong>T</strong></span>reatment required for reaction</p>", "md_calc_info_concept": null, "name": "t", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes/unknown", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

published

2022-05-24T18:47:11.516Z

purpose

[ "Prognosis" ]

search_terms

[ "Penicillin Allergy Decision Rule (PEN-FAST)", "pen-fast", "penicillin", "penicillin allergy", "allergy", "penicillin allergy rule" ]

seo

{ "keywords_en": "Penicillin Allergy Decision Rule (PEN-FAST), pen-fast, penicillin, penicillin allergy, allergy, penicillin allergy rule, allergy to penicillin", "meta_description_en": "The Penicillin Allergy Decision Rule (PEN-FAST) identifies low-risk penicillin allergies." }

specialty

[ "Allergy and Immunology", "Dermatology" ]

departments

[ "Allergic", "Dermatologic", "Immunologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 3385, "short_title_en": "PIAMA Risk Score", "slug": "prevention-incidence-asthma-mite-allergy-piama-risk-score" }, { "calcId": 10557, "short_title_en": "MAPS Score", "slug": "mayo-alliance-prognostic-system-maps-score" }, { "calcId": 10554, "short_title_en": "REMA Score", "slug": "spanish-network-mastocytosis-rema-score" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "immunology", "dermatology", "immunology" ]

cleaned_use

[ "Indicated for patients with a reported penicillin allergy to assess allergy risk, especially when considering penicillin or related β-lactam therapy." ]

pub

false