Patient selection: patient gives a history of penicillin allergy
Parameters:
(1) number of years since last reaction
(2) anaphylaxis or angioedema during event
(3) severe cutaneous adverse reaction (SCAR = Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS, acute generalized erythematous pustulosis)
(4) treatment required for reaction
Pneumonic: PEN-FAST (penicillin, five, anaphylaxis/angioedema, skin, treatment)
|
Parameter
|
Finding
|
Points
|
|
number of years since reaction
|
> 5 years
|
0
|
|
|
<= 5 years
|
2
|
|
features of the reaction
|
anaphylaxis
|
2
|
|
|
angioedema
|
2
|
|
|
severe cutaneous
|
2
|
|
|
none of these
|
0
|
|
treatment required
|
yes
|
1
|
|
|
unknown
|
1
|
|
|
no
|
0
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the more likely that there will be a positive penicillin allergy test.
|
Score
|
Risk Group
|
Positive Skin Test
|
|
0
|
very low
|
< 1%
|
|
1 or 2
|
low
|
5%
|
|
3
|
moderate
|
20%
|
|
4 or 5
|
high
|
50%
|
