Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule

Piotin, A; Godet, J; Trubiano, JA; Grandbastien, M; Guenard-Bilbault, L; de Blay, F; Metz-Favre, C

Author(s): Piotin, A; Godet, J; Trubiano, JA; Grandbastien, M; Guenard-Bilbault, L; de Blay, F; Metz-Favre, C;
Details: Publication Year 2022-01,Volume 128,Issue #1,Page 27-32
Journal Title: Annals of Allergy, Asthma & Immunology
Publication Type: Research article
Abstract: BACKGROUND: The challenge of delabeling amoxicillin allergy is an important issue for patients and clinicians, especially when anaphylaxis is reported. A recent study has proposed a clinical decision rule, PEN-FAST, to identify low-risk penicillin allergies. OBJECTIVE: To validate the PEN-FAST clinical decision rule in a population with high risk of suspected immediate amoxicillin allergy and to identify clinical predictive factors of amoxicillin immediate hypersensitivity. METHODS: We retrospectively analyzed medical records of patients with a suspected immediate amoxicillin allergy who carried out an allergologic evaluation by a specialist in the Allergy Unit of Strasbourg University Hospital from 2015 to 2020. RESULTS: A total of 142 adult patients (88 women [62.0%]; median age, 52 [interquartile range, 40.3-62.0] years) were analyzed. Most of them reported anaphylaxis (68.8%). Internal validation of PEN-FAST score revealed a good discrimination with area under the curve of 0.86 (95% confidence interval, 0.79-0.92). A cutoff of less than 3 points for PEN-FAST was used to classify 29 from 142 patients at low risk of allergy, of whom only 2 (6.9%) received positive results of allergy testing. The negative predictive value for successful delabeling was 0.93 (95% confidence interval, 0.77-0.99). Predictive clinical features for immediate amoxicillin hypersensitivity were time since reaction (P < .001), time elapsed between drug intake and first symptom (P < .001), severity grade reaction (P < .001), and treatment or hospitalization required (P < .001). CONCLUSION: PEN-FAST has been validated to identify low-risk penicillin allergies in our European cohort of patients mainly reporting anaphylaxis. This is the first reported external validation of a penicillin allergy clinical decision rule internationally.
Keywords: Adult; *Amoxicillin/adverse effects; *Anaphylaxis/chemically induced/diagnosis/epidemiology; Anti-Bacterial Agents/adverse effects; *Clinical Decision Rules; *Drug Hypersensitivity/diagnosis/epidemiology; Female; Humans; *Hypersensitivity, Immediate; Middle Aged; Penicillins/adverse effects; Retrospective Studies; Skin Tests
Department(s): Infectious Diseases
PubMed ID: 34271183
Publisher's Version: https://doi.org/10.1016/j.anai.2021.07.005
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-02-20 06:41:18

Last Modified: 2025-02-20 06:42:28