Podcast 600: Penicillin Allergy?

Contributor: Aaron Lessen, MD

Educational Pearls:

• True allergies to penicillin compared to reported allergies from patients ranges around 10%
• Recent study took patients undergoing sensitivity tests and developed the PEN(icillin)-FAST score to address reported penicillin allergies
• PEN-FAST has four components for a total score of 0-4:

o F = five years or less since prior reaction.

o A = Angioedema/Anaphylaxis.

o S = Severe cutaneous reaction (rash).

o T = Treatment, did they require treatment for a reaction?

• Patients with a score of 0 had <1% incidence of penicillin allergy
• Even a score of 1-2 points had around 5% incidence of a true allergy

References

Trubiano JA, Vogrin S, Chua KYL, Bourke J, Yun J, Douglas A, Stone CA, Yu R, Groenendijk L, Holmes NE, Phillips EJ. Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Intern Med. 2020 May 1;180(5):745-752. doi: 10.1001/jamainternmed.2020.0403. PMID: 32176248; PMCID: PMC7076536.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD