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PEN-FAST score to predict penicillin allergy not useful in pediatric population
Clinical Question
Is the PEN-FAST score accurate for predicting a true penicillin allergy in children 12 years or younger?
Bottom line
Although the PEN-FAST score is useful in identifying adults at low risk of a true penicillin allergy, the same tool is not useful in the pediatric population. 1b
Reference
Study design: Decision rule (validation)
Funding: Self-funded or unfunded
Setting: Outpatient (any)
Synopsis
These investigators examined the accuracy of the PEN-FAST score in a cohort of 2028 children, median age 4.3 (2.1 - 8.0) years, with a penicillin allergy label from August 2011 to March 2021. Of these, 107 (5.3%) had a positive oral challenge allergy test result. For patients who report a PENicillin allergy, here is the FAST rule: Five years or less since the reaction: 2 points; Anaphylaxis (or angioedema) or Severe cutaneous reaction: 2 points; Treatment required for reaction: 1 point. Using the adult PEN-FAST score cutoff of 3 or greater, the sensitivity and specificity for a true allergy were 57% (95% CI 47.1% - 66.5%) and 45.7% (43.5% - 48.0%), respectively. The negative predictive value of 95% is considered of low usefulness since the prevalence was already 5%. In addition, none of the individual variables were associated with a positive test result. Changing the time interval to less than 1 year or removing angioedema did not improve test performance. Similarly, a secondary analysis of children 13 years or older also showed unreliable test performance.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Pen-Fast not helpful in kids
Pen-Fast not helpful in predicting penicillin allergy in kids like it is in adults.
PEN-FAST score to predict penicillin allergy not useful in p
Very strange that this predictive score claimed to be helpful in adults is really just a crap shoot in pediatrics. It makes we wonder whether further validation of this score in adults is warranted "just to be sure". At this point, I wouldn't consider using this score in adults until more research is done.
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pen fast assessment
not accurate in peds