Although ST have traditionally been advocated (especially for suspected IgE-mediated reactions), their low reproducibility and variable positive predictive value diminishes its value among low-risk cohorts - where the pre-test probability of genuine penicillin allergy is already low.45, 46, 47 Other reported pharmacist-led penicillin allergy services have skipped ST in their practice and report similar safety.48, 49, 50 Following findings from HK-PAPI, our pharmacists have also started to conduct direct DPT among patients with low-risk penicillin allergy since 2024. This evidence concerns the gene IGHE and response to penicillin.