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This protocol is an extension of the widely accepted PEN-FAST (penicillin allergy reported by patient, five years or less since reaction, anaphylaxis or angioedema, severe cutaneous adverse reaction, and treatment required for reaction) clinical decision tool that has been used to identify patients with reported penicillin allergy who are appropriate for DOC rather than immediate hypersensitivity skin testing, which recent data suggest has poor positive predictive value in low-risk patients