ArticleFrontiers in pharmacology2026
Towards an optimized approach for de-labeling penicillin allergy: comparison between PEN-FAST and PEN-FAST+ in an Italian cohort.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: According to allergy work-up, fewer than 10% of adult and children who report a suspected penicillin allergy are actually allergic. The PEN-FAST score is currently validated for identifying patients at low-risk of penicillin allergy who benefit from a direct challenge test. The PEN-FAST+ has been developed with the aim of improving accuracy. Objectives: The aim of this study was to compare the performance of the PEN-FAST score and PEN-FAST+ score, with the aim of identifying the best clinical decision score to apply in daily practice to simplify and implement the de-labeling processes of penicillins allergy. Methods: Phase I: Retrospective evaluation of the PEN-FAST score and PEN-FAST+ score in patients with proven penicillin allergy. Phase II: Comparison of diagnostic performances of PEN-FAST and PEN-FAST+ scores. Results: 288 patients were studied for suspected beta-lactams allergy. 245 had a reported history of penicillin allergy. A total of 32/245 (13%) patients were confirmed to be allergic to penicillin according to EAACI/ENDA definition. The PEN-FAST score showed limited discrimination capacity (AUC = 0.639 and NPV 93.75%). For immediate allergic penicillin, PEN-FAST misclassified 31% of patients (5/16) while PEN-FAST+ nobody. Both PEN-FAST and PEN-FAST+, misclassified 30% of patients (3/10) with delayed hypersensitivity. For unknown timing hypersensitivity reactions, PEN-FAST misclassified 33%% of patients (2/6) while PEN-FAST+ 67% (4/6). The AUC (0.810 vs. 0.639, p < 0.001) and NVP (96.59% vs. 93.75%), was significantly higher for PEN-FAST+ than PEN-FAST. Conclusion: Integrating PEN-FAST+ into diagnostic pathways could streamline patient selection for provocation tests, reduce false negatives, and optimize hospital resource use.
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