ArticleThe journal of allergy and clinical immunology. Global2026
Evaluating penicillin allergy clinical decision-making tools to enhance penicillin allergy delabeling.
Article in The journal of allergy and clinical immunology. Global, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
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Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Are Basophil Activation Test (BAT) and IgE Levels Useful Tools in Confirming Penicillin Allergy? Novel Diagnostic Approach in Beta-Lactams Hypersensitivity Reactions: A Systematic Review.International journal of molecular sciences · 2026Pooled it
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Patient-reported penicillin allergy is associated with adverse outcomes. Objective: We aimed to evaluate clinical decision-making tools used to risk-stratify reported penicillin allergies for delabeling. Methods: Retrospective chart review of patients with reported penicillin allergies who underwent testing from October 9, 2020, to October 8, 2022 was completed at a tertiary referral health care system. Follow-up surveys were conducted to assess penicillin use after testing. The PEN-FAST clinical decision rule, 1-1-1 rule, Siew score, and Vanderbilt criteria were evaluated. Results: Of the 137 patients who underwent penicillin allergy evaluations, 58 completed follow-up surveys. In all, 48 patients (82.8%) had skin testing, and 46 patients had penicillin challenge following negative skin testing. Of the 10 patients (17.2%) who underwent direct challenge, none had reactions. A total of 4 patients (6.9%) tested positive; 2 had positive skin test results and 2 had negative skin test results but failed oral challenges. In predicting a positive penicillin test, the negative predictive values of the PEN-FAST (score ≤ 2), 1-1-1 rule (score ≤ 2), Siew score (score = 0), and Vanderbilt criteria with only low-risk features were 100% (95% CI = 92.0%-100.0%), 91.3% (95% CI = 72.0%-98.9%), 100.00% (95% CI = 79.4%-100.0%), and 96.6% (95% CI = (82.2%-99.9%), respectively. Of the 54 patients (93.1%) who had negative test results, 21 (38.9%) received subsequent courses of penicillin (to which 18 had no reaction and 3 had delayed rashes); none developed anaphylaxis. Conclusions: Direct challenge was underutilized in penicillin allergy evaluations even though most patients tested had low-risk histories. The PEN-FAST, 1-1-1 rule, Siew score, and Vanderbilt criteria were all associated with high negative predictive values in our cohort, thus effectively identifying low-risk patients. We advocate the use of these tools to enhance penicillin allergy delabeling.
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