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The Safety and Accuracy of Drug Patch Testing in Delayed Hypersensitivity Reactions

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Abstract

Purpose of Review

Adverse drug reactions are common in both the inpatient and outpatient settings and lead to limitations in future treatment options. Patch testing, used in conjunction with clinical history and the reaction phenotype, can help to improve identification of the culprit medication and evidence for its use is growing. Here we discuss a standardized approach to patch testing which can lead to accurate and reproducible results.

Recent Findings

Although patch testing may have low sensitivity, specificity is generally high with good utility depending on reaction phenotype and implicated medication. Patch testing has the highest sensitivity for acute generalized exanthematous pustulosis and drug reaction with eosinophilia and systemic symptoms and at the site of fixed drug eruptions. It has the lowest sensitivity in Stevens-Johnson/toxic epidermal necrolysis.

Summary

Patch testing, used in conjunction with clinical history, can help to improve identification of the culprit medication depending on reaction phenotype. Overall, it is safe to perform patch testing with rare risk of reactivation of primary reaction.

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Abbreviations

AGEP:

Acute generalized exanthematous pustulosis

DRESS:

Drug reaction with eosinophilia and systemic symptoms

FDE:

Fixed drug eruption

GBFDE:

Generalized bullous fixed drug eruption

MPE:

Maculopapular exanthem

PT:

Patch testing

SCAR:

Severe cutaneous adverse drug reactions

SJS/TEN:

Stevens-Johnson/toxic epidermal necrolysis

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Authors and Affiliations

  1. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Yawkey 4B, Boston, MA, 02114, USA

    Rebecca R. Saff & Jamie L. Waldron

  2. Harvard Medical School, Boston, MA, USA

    Rebecca R. Saff & Jamie L. Waldron

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  1. Rebecca R. Saff
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R. Saff and J. Waldron contributed equally to the writing and editing of this manuscript.

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Correspondence to Rebecca R. Saff.

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Saff, R.R., Waldron, J.L. The Safety and Accuracy of Drug Patch Testing in Delayed Hypersensitivity Reactions. Curr Derm Rep 12, 260–268 (2023). https://doi.org/10.1007/s13671-023-00405-9

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