{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:51:58Z","timestamp":1792162318564,"version":"4.4.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>According to allergy work-up, fewer than 10% of adult and children who report a suspected penicillin allergy are actually allergic. The PEN-FAST score is currently validated for identifying patients at low-risk of penicillin allergy who benefit from a direct challenge test. The PEN-FAST+ has been developed with the aim of improving accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to compare the performance of the PEN-FAST score and PEN-FAST+ score, with the aim of identifying the best clinical decision score to apply in daily practice to simplify and implement the de-labeling processes of penicillins allergy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Phase I: Retrospective evaluation of the PEN-FAST score and PEN-FAST+ score in patients with proven penicillin allergy. Phase II: Comparison of diagnostic performances of PEN-FAST and PEN-FAST+ scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>288 patients were studied for suspected beta-lactams allergy. 245 had a reported history of penicillin allergy. A total of 32\/245 (13%) patients were confirmed to be allergic to penicillin according to EAACI\/ENDA definition. The PEN-FAST score showed limited discrimination capacity (AUC = 0.639 and NPV 93.75%). For immediate allergic penicillin, PEN-FAST misclassified 31% of patients (5\/16) while PEN-FAST+ nobody. Both PEN-FAST and PEN-FAST+, misclassified 30% of patients (3\/10) with delayed hypersensitivity. For unknown timing hypersensitivity reactions, PEN-FAST misclassified 33%% of patients (2\/6) while PEN-FAST+ 67% (4\/6). The AUC (0.810 vs. 0.639, p &amp;lt; 0.001) and NVP (96.59% vs. 93.75%), was significantly higher for PEN-FAST+ than PEN-FAST.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integrating PEN-FAST+ into diagnostic pathways could streamline patient selection for provocation tests, reduce false negatives, and optimize hospital resource use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1788547","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:09:08Z","timestamp":1780034948000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Towards an optimized approach for de-labeling penicillin allergy: comparison between PEN-FAST and PEN-FAST+ in an Italian cohort"],"prefix":"10.3389","volume":"17","author":[{"given":"Giada","family":"Sambugaro","sequence":"first","affiliation":[{"name":"Department of Public Health and Medical Science, University of Cagliari","place":["Cagliari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittoria","family":"Giagu","sequence":"additional","affiliation":[{"name":"Department of Public Health and Medical Science, University of Cagliari","place":["Cagliari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Pina","family":"Barca","sequence":"additional","affiliation":[{"name":"Department of Public Health and Medical Science, University of Cagliari","place":["Cagliari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Giovanni","family":"Ledda","sequence":"additional","affiliation":[{"name":"Department of Public Health and Medical Science, University of Cagliari","place":["Cagliari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Costanzo","sequence":"additional","affiliation":[{"name":"Department of Public Health and Medical Science, University of Cagliari","place":["Cagliari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Del Giacco","sequence":"additional","affiliation":[{"name":"Department of Public Health and Medical Science, University of Cagliari","place":["Cagliari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Firinu","sequence":"additional","affiliation":[{"name":"Department of Public Health and Medical Science, University of Cagliari","place":["Cagliari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1111\/all.15996","article-title":"EAACI\/ENDA position paper on drug provocation testing","volume":"79","author":"Barbaud","year":"2024","journal-title":"Allergy"},{"key":"B2","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/S0140-6736(18)32218-9","article-title":"Antibiotic allergy","volume":"393","author":"Blumenthal","year":"2019","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1001\/jamainternmed.2020.2227","article-title":"Association between penicillin allergy documentation and antibiotic use","volume":"180","author":"Blumenthal","year":"2020","journal-title":"JAMA Intern Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"h5527","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1302567","DOI":"10.3389\/falgy.2023.1302567","article-title":"Assessing delayed penicillin hypersensitivity using the PENFAST+ score","volume":"4","author":"Castagna","year":"2023","journal-title":"Front. 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