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• W4362704569 abstract "About 10–15% of individuals report a suspected allergy to penicillin are truly allergic. Skin tests (ST) followed by drug provocation test (DPT) with penicillin is the gold standard method but is time consuming. Trubiano et al. had been developed and validated a clinical decision rule [1]; a PEN-FAST score of less than 3 identify patients with low-risk penicillin allergy. Our objective was to improve PEN-FAST score to use it for delabelling patient suspected with penicillin allergy. First, we evaluated PEN-FAST in a retrospective cohort (27 proved penicillin allergic patients). PEN-FAST had a limited efficacy to predict the relapse of skin and mucosal immediate hypersensitivity (HS) or delayed maculopapular exanthema with respectively 28.6 and 38.4% of patients misclassified. Secondly, after reviewing the medical records of misclassified patients and according to the literature, we identified 2 potential additional criteria: skin rash lasting more than 7 days, and immediate reaction occurring in less than 1 hour. Then, we developed a new score using these 2 additional criteria (PEN-FAST+) and to compare its diagnosis performances with those of PEN-FAST in a prospective cohort of 252 successive patients with suspected or confirmed penicillin HS (with multivariable model). With PEN-FAST+, only 1 allergic patient with delayed HS confirmed with skin tests (ST) was misclassified (3.7%). With PEN-FAST+, 96.3% of patients with positive ST and 90.6% of truly allergic patients (proven by positive ST or drug provocation test) were correctly identified, in comparison with 55.6% and 56.2% respectively with PEN-FAST. The AUC of the ROC curve of PEN-FAST+ was significantly higher than the one of PEN-FAST (85% vs. 72%, P = 0.03). We proposed here the PEN-FAST+ score with 2 additional criteria for delabelling patient suspected with penicillin allergy. A large prospective and multicentric study is needed to validate that PEN-FAST+ can accurately select low risk of reaction's patients who could have direct drug provocation test without previous ST." @default.
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• W4362704569 date "2023-04-01" @default.
• W4362704569 modified "2023-10-03" @default.
• W4362704569 title "The PEN-FAST+: Two additional criteria to improve negative predictive value for the penicillin allergy clinical decision rule PEN-FAST in adults" @default.
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• W4362704569 doi "https://doi.org/10.1016/j.reval.2023.103479" @default.
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