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Basophil Activation Test for Investigation of IgE-Mediated Mechanisms in Drug Hypersensitivity

Basophil Activation Test for Investigation of IgE-Mediated Mechanisms in Drug Hypersensitivity

Published on: September 16, 2011

Assessing delayed penicillin hypersensitivity using the PENFAST+ score.

Julie Castagna¹, François Chasset^1,2, Jean-Eric Autegarden¹

¹Médecine Sorbonne Université, Service de dermatologie et d'allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.

Frontiers in Allergy

|November 29, 2023

Summary

This summary is machine-generated.

The PEN-FAST+ score improves penicillin allergy diagnosis, especially for delayed hypersensitivity reactions. This enhanced tool better identifies patients with low-risk penicillin allergy, reducing misclassifications.

Keywords:

PEN-FAST clinical decision rule delabelling delayed hypersensitivity diagnostic score drug hypersensitivity penicillin allergy

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Last Updated: Jun 27, 2026

Basophil Activation Test for Investigation of IgE-Mediated Mechanisms in Drug Hypersensitivity

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Published on: September 16, 2011

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Precision Implementation of Minimal Erythema Dose MED Testing to Assess Individual Variation in Human Inflammatory Response

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Published on: October 3, 2019

Area of Science:

Clinical Medicine
Allergy and Immunology
Pharmacology

Background:

Penicillin allergy is over-reported, with low confirmation rates after allergy work-ups.
The PEN-FAST score aids in identifying low-risk penicillin allergy but has limitations, particularly for delayed hypersensitivity.
Improving diagnostic accuracy for penicillin hypersensitivity is crucial to avoid unnecessary antibiotic avoidance.

Purpose of the Study:

To enhance the PEN-FAST score's performance, specifically its negative predictive value for delayed penicillin hypersensitivity.
To identify additional clinical criteria to improve the accuracy of the PEN-FAST score in diagnosing penicillin allergy.

Main Methods:

Retrospective evaluation of the PEN-FAST score in patients with confirmed immediate and delayed penicillin allergy.
Identification of new criteria in misclassified patients to develop the PEN-FAST+ score.
Prospective validation of the PEN-FAST+ score in a cohort of patients with suspected penicillin hypersensitivity.

Main Results:

The original PEN-FAST score misclassified a significant proportion of patients with delayed hypersensitivity (37%).
New criteria, including rash duration and timing/characteristics of immediate reactions, were identified.
The PEN-FAST+ score demonstrated improved diagnostic performance, with a higher Area Under the Curve (AUC) of 85% compared to PEN-FAST's 72% (p=0.03).

Conclusions:

The PEN-FAST+ score offers superior diagnostic accuracy for penicillin allergy compared to the original PEN-FAST score.
This improved score is particularly beneficial for accurately identifying patients with delayed hypersensitivity reactions.
The PEN-FAST+ score can help reduce misdiagnosis and improve antibiotic stewardship in patients with suspected penicillin allergy.