{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:45:14Z","timestamp":1792626314074,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>A false\u00a0penicillin allergy label often leads to the unnecessary avoidance of beta\u2010lactam antibiotics, contributing to antimicrobial resistance and suboptimal clinical outcomes. The PEN\u2010FAST clinical decision rule is a simple, point\u2010of\u2010care tool with a high negative predictive value (NPV) designed to identify low\u2010risk patients who may not require extensive allergy testing. This study aims to validate the performance of the PEN\u2010FAST clinical decision rule in an Asian population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of medical records from January 2006 to February 2023 was conducted at our institution's outpatient allergy clinic. Patients underwent skin prick and intradermal testing, followed by oral drug provocation testing (DPT) or direct oral DPT without prior skin testing (ST). Positive results were defined as positive skin test outcomes or immediate\/delayed reactions following drug challenge. PEN\u2010FAST scores were compared to allergy testing results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 357 patients were included, with 85 (23.8%) undergoing direct DPT without prior ST. None had a history of severe cutaneous allergic reaction as their index reaction. The median age was 49\u2009years (interquartile range [IQR]: 34\u201363), and 61.9% were female. Forty\u2010seven patients (13.2%) had positive test results, including 26 positive reactions following DPT. PEN\u2010FAST scores of 0\u20135 were distributed as follows: 25 (7.0%), 159 (44.5%), 31 (8.7%), 96 (26.9%), 4 (1.1%) and 42 (11.8%). Among those with PEN\u2010FAST scores \u2264\u20092 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009215), 16 (7.4%) had a positive test. Of these, 7 developed urticaria, 8 developed mild delayed maculopapular exanthem and 1 had a positive skin test. A PEN\u2010FAST score cutoff of \u2264\u20092 yielded sensitivity of 66.0% (95% CI: 50.7%\u201379.1%), specificity of 64.2% (95% CI: 58.6%\u201369.5%), a positive predictive value (PPV) of 21.8% (95% CI: 17.8%\u201326.5%) and a NPV of 92.6% (95% CI: 89.2%\u201394.9%). The area under the receiver operating characteristic curve was 0.66 (95% CI: 0.58\u20130.75).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The PEN\u2010FAST clinical decision rule demonstrates a high NPV in an Asian population, supporting its potential utility in identifying individuals unlikely to have true penicillin allergy and enabling direct DPT in low\u2010risk patients without prior ST. However, the modest area under the curve (AUC) of 0.66 reflects limited overall discriminatory ability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cea.70164","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T07:20:51Z","timestamp":1761376851000},"page":"402-410","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Validation of the PEN\u2010FAST Penicillin Allergy Clinical Decision Rule in an Asian Cohort"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1167-353X","authenticated-orcid":false,"given":"Xin Rong","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan Xuan Wei","family":"Teo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justina Wei\u2010Lyn","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze\u2010Chin","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4060-5525","authenticated-orcid":false,"given":"Khai\u2010Pang","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith Li\u2010Ann","family":"Chia","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Shang\u2010Ming","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0384-1740","authenticated-orcid":false,"given":"Claire Min\u2010Li","family":"Teo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace Yin\u2010Lai","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6338-8482","authenticated-orcid":false,"given":"Bernard Yu\u2010Hor","family":"Thong","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2500\/aap.2014.35.3791"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1807761"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.12881"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.09.021"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2022.100677"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2019.100048"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.14624"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2019.09.017"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2010.08.002"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-015-0063-6"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k2400"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2014-202438"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2010.12.014"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.5415\/apallergy.0000000000000020"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.12350"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.0403"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.2986"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2007.02.064"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2020.08.006"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40629-015-0052-6"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0105-4538.2001.00001.x-i8"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2021.07.005"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.1572"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.33703"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/falgy.2023.1302567"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/falgy.2024.1439698"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.14122"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2015.05.011"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.19283"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.5415\/apallergy.0000000000000122"}],"container-title":["Clinical &amp; Experimental Allergy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cea.70164","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cea.70164","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cea.70164","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:35:49Z","timestamp":1792625749000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cea.70164"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,25]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/cea.70164"],"URL":"https:\/\/doi.org\/10.1111\/cea.70164","archive":["Portico"],"relation":{},"ISSN":["0954-7894","1365-2222"],"issn-type":[{"value":"0954-7894","type":"print"},{"value":"1365-2222","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,25]]},"assertion":[{"value":"2025-05-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}