Abstract
Skin tests are crucial to detect sensitization in drug hypersensitivity. Three skin tests, patch test, skin prick test (SPT), and intradermal test (IDT), are used for the etiological diagnosis of an adverse reaction, but also to find an alternative drug in case of confirmed drug hypersensitivity. Drug patch tests have a rather low sensibility, but are well tolerated. They are of value for the investigation of maculopapular exanthema, systemic contact dermatitis, symmetrical drug-related intertriginous and flexural exanthema, eczematous reactions at injection sites, acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN). Drug SPT can be done with all drugs except opiates with a low sensitivity and a good specificity. They are primarily used for immediate hypersensitivity reactions, even if some cases of delayed positivity have been reported. Intradermal tests explore immediate and delayed hypersensitivity reactions. Except for SJS/TEN, they are done by injecting 0.02 mL of the drug intradermally in recommended dilutions. After 20 min, a positive reaction is defined by a wheal with a diameter of ≥ the initial wheal +3 mm and if there is a surrounding erythema. Many injectable drugs can be tested by IDT, such as antibiotics, radiocontrast media, or platinum salts.
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References
Torres MJ, Romano A, Celik G, Demoly P, Khan DA, Macy E, Park M, Blumenthal K, Aberer W, Castells M, Barbaud A, Mayorga C, Bonadonna P. Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America. Clin Transl Allergy. 2017;7:7.
Phillips EJ, Bigliardi P, Bircher AJ, Broyles A, Chang YS, Chung WH, Lehloenya R, Mockenhaupt M, Peter J, Pirmohamed M, Roujeau JC, Shear NH, Tanno LK, Trubiano J, Valluzzi R, Barbaud A. Controversies in drug allergy: testing for delayed reactions. J Allergy Clin Immunol. 2019;143:66–73.
Barbaud A, Collet E, Milpied B, Assier H, Staumont D, Avenel-Audran M, et al. A multicenter study to determine the value and safety of drug patch tests for the three main classes of severe cutaneous adverse drug reactions. Br J Dermatol. 2013;168:555–62.
Barbaud A, Gonçalo M, Bruynzeel D, Bircher A. Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Contact Dermatitis. 2001;45:321–8.
Barbaud A. Skin testing and patch testing in non-IgE-mediated drug allergy. Curr Allergy Asthma Rep. 2014;14:442–8.
Conilleau V, Dompmartin A, Michel M, Verneuil L, Leroy D. Photoscratch testing in systemic drug-induced photosensitivity. Photodermatol Photoimmunol Photomed. 2000;16:62–6.
Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002;57:45–51.
Brajon D, Menetre S, Waton J, Poreaux C, Barbaud A. Non-irritant concentrations and amounts of active ingredient in drug patch tests. Contact Dermatitis. 2014;71:170–5.
Assier H, Valeyrie-Allanore L, Gener G, Verlinde Carvalh M, Chosidow O, Wolkenstein P. Patch testing in non-immediate cutaneous adverse drug reactions: value of extemporaneous patch tests. Contact Dermatitis. 2017;77:297–302.
Indradat S, Veskitkul J, Pacharn P, Jirapongsananuruk O, Visitsunthorn N. Provocation proven drug allergy in Thai children with adverse drug reactions. Asian Pac J Allergy Immunol. 2016;34:59–64.
Barbaud A, Weinborn M, Garvey LH, Testi S, Kvedariene V, Bavbek S, Mosbech H, Gomes E, Aberer W, Elberink HNGO, Torres MJ, Ponvert C, Ayav C, Gooi J, Brockow K. Intradermal tests with drugs: an approach to standardization. Front Med (Lausanne). 2020;7:156.
Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. ENDA/EAACI Drug Allergy Interest Group. Skin test concentrations for systemically administered drugs—an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68:702–12.
Romano A, Atanaskovic-Markovic M, Barbaud A, Bircher AJ, Brockow K, Caubet JC, Celik G, Cernadas J, Chiriac AM, Demoly P, Garvey LH, Mayorga C, Nakonechna A, Whitaker P, Torres MJ. Towards a more precise diagnosis of hypersensitivity to beta-lactams—an EAACI position paper. Allergy. 2020;75:1300–15.
Ewan PW, Dugué P, Mirakian R, Dixon TA, Harper JN, Nasser SM. BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia. Clin Exp Allergy. 2010;40:15–31.
Mertes PM, Malinovsky JM, Jouffroy L, Working Group of the SFAR and SFA, Aberer W, Terreehorst I, Brockow K, Demoly P, ENDA, EAACI Interest Group on Drug Allergy. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21:442–53.
Pinho A, Marta A, Coutinho I, Gonçalo M. Long-term reproducibility of positive patch test reactions in patients with non-immediate cutaneous adverse drug reactions to antibiotics. Contact Dermatitis. 2017;76:204–9.
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Barbaud, A. (2022). Skin Tests. In: Bircher, A.J., Maibach, H.I., Brockow, K., Barbaud, A. (eds) Cutaneous Drug Hypersensitivity. Springer, Cham. https://doi.org/10.1007/978-3-030-82743-4_7
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DOI: https://doi.org/10.1007/978-3-030-82743-4_7
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