ID:IOTS - Infectious Disease Insight Of Two Specialists 129. Penicillin allergy 3: CEPH FAST
Jan 12, 2026
Fionnuala Cox, a consultant immunologist specializing in drug allergies, joins the discussion to illuminate the complexities of cephalosporin allergy. The conversation centers around the innovative CEPH-FAST risk assessment tool, designed for accurate allergy identification. Fionnuala explains the importance of delabelling antibiotic allergies, the challenges of skin testing, and the significance of understanding hypersensitivity reactions. They also delve into the practical applications of CEFAST, cross-reactivity guidance, and the implications of retaining allergy labels in clinical settings.
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Use PENFAST For Immediate Risk Stratification
- Use PENFAST at point-of-care to risk-stratify suspected penicillin allergies and guide delabelling decisions.
- Direct oral challenge is safe for low-score (0–2) patients and avoids routine skin testing.
Pharmacist‑Led Delabelling Worked Locally
- James described implementing pharmacist‑led and trainee‑led penicillin delabelling services successfully in hospital.
- Funding loss halted the service but demonstrated that non‑specialists can safely delabel.
KEFFAST Mirrors PENFAST For Cephalosporins
- KEFFAST adapts PENFAST logic to cephalosporin allergies using similar questions about timing, anaphylaxis, SCAR and treatment.
- It provides point-of-care reassurance though its low-score negative predictive value is slightly weaker than PENFAST.