(1045) Utilizing the PEN-FAST Scoring Tool in Pregnant Patients for Syphilis Management Complicated by Penicillin Allergy

This was a single center, retrospective, case cohort study of pregnant patients with confirmed Syphilis requiring treatment and a reported penicillin allergy between August 2022 through August 2023.

Results:

There were six patients included in analysis. Three patients had a PEN-FAST score of zero, two of whom had direct de-labeling of the penicillin allergy while one patient had an oral challenge followed by allergy de-labeling. Three patients had a PEN-FAST score of three. One of these patients had a successful oral challenge with subsequent penicillin allergy de-labeling, one patient received an IV test dose followed by a continuous penicillin infusion and subsequent penicillin allergy de-labeling, and one patient required admission to the intensive care unit for desensitization. All patients were successfully treated for syphilis with penicillin without adverse drug reactions, with only one requiring desensitization. Overall, four out of six patients had their penicillin allergy successfully de-labeled as one patient had a true allergy and one declined de-label. Patients with a documented penicillin allergy had a significant delay in time to treatment compared to patients without a documented penicillin allergy presenting with syphilis during the same time period.

Conclusion:

Overall, the PEN-FAST assessment was an efficient and safe tool for stratifying risk of penicillin allergies within this cohort of patients. The clinical impact of this assessment includes decreased utilization of healthcare resources and improved time to treatment for pregnant patients with syphilis. The PEN-FAST scoring tool in combination with direct oral challenge when needed, resulted in the safe, effective, and timely treatment of six pregnant patients with syphilis.