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Emergency Medical Minute


Sep 29, 2020

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


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