For which patients could you consider direct oral amoxicillin challenge as opposed to skin testing for penicillin allergy de-labeling?

If a patient can be identified as low-risk by history they should be considered for either historical removal of the label of direct oral challenge. If the history is not compatible with allergy (e.g. they have a family history or have tolerated another drug like Augmentin), historical de-labeling is appropriate. Low-risk patients with a history of penicillin allergy are those with who had non-allergic sounding symptoms (e.g. nausea, headache), did not receive treatment for their previous reaction, had mild to moderate symptoms (e.g. delayed skin rash).

There are scoring tools like the PEN-FAST which can identify those with low-risk penicillin allergy and a randomized open clinical trial that used the PEN-FAST score showed that direct oral ...

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