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Skin Tests in Evaluating Drug Eruptions

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Drug Eruptions

Part of the book series: Updates in Clinical Dermatology ((UCD))

Abstract

Identifying the causative drug in immune-mediated cutaneous adverse drug reaction can be challenging. Skin tests are useful diagnostic tools; however, the choice is determined by the clinical pattern of the drug eruption and its underlying mechanism. Skin prick tests and intradermal tests with immediate readings are indicated for urticaria and anaphylactic reactions, whereas patch test and intradermal tests with late readings are useful for delayed reactions such as maculopapular exanthema (MPE); acute generalized exanthematous pustulosis (AGEP); symmetrical drug-related intertriginous and flexural exanthema (SDRIFE); drug reaction with eosinophilia and systemic symptoms (DRESS); as well as Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Lesional patch tests and photopatch testing are useful for fixed drug eruptions and drug photosensitivity, respectively. In addition, skin tests are useful for determining cross-reactivity across different drugs in the same drug class. Nevertheless, there are limitations to skin testing; these tests are not standardized, skin test positivity is dependent on drugs being evaluated, and the real sensitivity in relation to various culprit drugs and clinical phenotypes remains unclear.

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Abbreviations

ACE:

Angiotensin-converting enzyme

AGEP:

Acute generalized exanthematous pustulosis

CADR:

Cutaneous adverse drug reactions

DRESS:

Drug reaction with eosinophilia and systemic symptoms

EGF:

Epidermal growth factor

FDE:

Fixed drug eruption

IDT:

Intradermal tests

MED:

Minimal erythema dose

MPE:

Maculopapular exanthema

NSAIDs:

Nonsteroidal anti-inflammatory drugs NSAIDs

PaT:

Patch tests

SDRIFE:

Symmetrical drug-related intertriginous and flexural dermatitis

SJS/TEN:

Stevens–Johnson syndrome/toxic epidermal necrolysis

SPT:

Skin prick tests

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Authors and Affiliations

  1. Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Margarida Gonçalo

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  1. Margarida Gonçalo
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Correspondence to Margarida Gonçalo .

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Editors and Affiliations

  1. Department of Dermatology and Allergy Centre, Singapore General Hospital, Singapore, Singapore

    Haur Yueh Lee

  2. Department of Dermatology, King’s College Hospital, London, UK

    Daniel Creamer

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Gonçalo, M. (2022). Skin Tests in Evaluating Drug Eruptions. In: Lee, H.Y., Creamer, D. (eds) Drug Eruptions. Updates in Clinical Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-031-09388-3_4

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  • DOI: https://doi.org/10.1007/978-3-031-09388-3_4

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