IGHE and allergic disease: In addition, the more recently published guidelines favor proceeding to DOC without PST in adults with low-risk penicillin allergy histories, and utilizing PST primarily for patients with a history of anaphylaxis or a recent reaction suspected to be IgE-mediated (eg, immediate onset urticaria).5 If this pilot was repeated with this updated approach, it is likely that more patients would have been captured and delabeled.