Drug patch testing in systemic cutaneous drug allergy

Barbaud, A.

doi:10.1016/j.tox.2004.12.024

Cited by 124 publications

(64 citation statements)

References 71 publications

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“…Patch testing (PT) with some medications including CBZ have reproduced cutaneous ADRs; hence, in severe forms like DRESS, a starting concentration of 0.1-1 % is recommended (up to 10 % if negative) [47]. The value of PT seems to be dependent on the medication class.…”

Section: Assessment Of Drug Causalitymentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

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While peripheral or tissue eosinophilia may certainly characterize drug eruptions, this feature is hardly pathognomonic for a medication-induced etiology. While delayed drug hypersensitivity reactions with prominent eosinophilic recruitment have been typically classified as type IVb reactions, their pathophysiology is now known to be more complex. Eosinophilic drug reactions have a diversity of presentations and may be benign and self-limited to severe and life-threatening. The extent of clinical involvement is also heterogeneous, ranging from isolated peripheral eosinophilia or single organ involvement (most often the skin and lung) to systemic disease affecting multiple organs, classically exemplified by drug-reaction with eosinophilia and systemic symptoms (DRESS). The spectrum of implicated medications in the causation of DRESS is ever expanding, and multiple factors including drug metabolites, specific HLA alleles, herpes viruses, and immune system activation have been implicated in pathogenesis. Due to this complex interplay of various factors, diagnostic workup in terms of skin and laboratory testing has not been validated. Similarly, the lack of controlled trials limits treatment options. This review also describes other localized as well as systemic manifestations of eosinophilic disease induced by various medication classes, including their individual pathophysiology, diagnosis, and management. Given the multitude of clinical patterns associated with eosinophilic drug allergy, the diagnosis can be challenging. Considerable deficits in our knowledge of these presentations remain, but the potential for severe reactions should be borne in mind in order to facilitate diagnosis and institute appropriate management.

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Section: Assessment Of Drug Causalitymentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

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“…Drug patch testing might be useful for certain types of cutaneous drug reactions, including maculopapular exanthems, acute generalized exanthematous pustulosis, and fixed drug eruptions, but generally is not helpful for SJS or urticarial eruptions. 10 In complex cases in which multiple drugs are involved without a clear-cut temporal relationship, a skin biopsy might be useful. However, there are no absolute histologic criteria for the diagnosis of drug-induced eruptions, and a skin biopsy might not definitively exclude alternative causes.…”

Section: Laboratories In Drug Allergymentioning

confidence: 99%

Drug allergy

Khan

Solensky

2010

Journal of Allergy and Clinical Immunology

230

211

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Drug allergy is one type of adverse reaction to drugs and encompasses a spectrum of hypersensitivity reactions with heterogeneous mechanisms and clinical presentations. A thorough history is essential to the management of drug allergy. Laboratory testing has a very limited role in the management of drug allergy. Graded dose challenges and procedures to induce drug tolerance might be required in patients with drug allergy when there is a definite need for a particular agent. Management of reactions to specific agents, including beta-lactam antibiotics, sulfonamides, local anesthetics, radiocontrast media, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, and biologic modifiers, will be discussed in further detail.

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“…Recently, Notman et al [11] calculated a negative predictive value of merely 68% for exclusive prick and intradermal tests (without patch test) and proposed abandoning clindamycin skin testing as a diagnostic modality. However, performing combined prick and patch tests in 33 patients with suspected DTH to clindamycin, we obtained clearly positive results in 5 patients, and experience regarding clindamycin-associated exanthema suggests that skin test positivity is an indicator of DTH [6,11,12,13]. We observed that patch test reactions were stronger than prick reactions, and in 1 case only the patch test was positive.…”

Section: Discussionmentioning

confidence: 68%

Allergy Diagnostic Testing in Clindamycin-Induced Skin Reactions

Seitz

Bröcker

Trautmann³

2009

Int Arch Allergy Immunol

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Background: In clinical practice, clindamycin is increasingly used because of its good tolerability and high efficacy with excellent tissue penetration. However, with increased application of clindamycin, the frequency of side effects such as skin eruptions rises and the need for diagnostic testing to identify clindamycin allergy increases. The aim of this retrospective analysis was to demonstrate the results of skin and challenge tests in cases of clinically suspected clindamycin allergy. Methods: We evaluated 33 patients with a history of a skin reaction in temporal relation to treatment with clindamycin using standardized patch and prick skin testing. In the case of negative skin tests, oral challenges were performed. Results: Clindamycin hypersensitivity was excluded in 20 patients by negative skin tests and subsequently tolerated oral challenge tests. In 5 patients, positive skin tests strongly suggested delayed-type non-IgE-mediated allergic clindamycin hypersensitivity. In 6 skin test-negative patients (2 patients refused challenge tests), a rash was provoked by controlled challenge tests. Conclusions: The evaluation of patients with clindamycin-associated skin reactions should include appropriate allergologic tests establishing or excluding the diagnosis of clindamycin hypersensitivity. Combined testing, i.e. skin tests and subsequent challenge tests, appears to be necessary to definitely confirm or rule out the presence of allergic clindamycin hypersensitivity.

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Drug patch testing in systemic cutaneous drug allergy

Cited by 124 publications

References 71 publications

Eosinophilic Drug Allergy

Eosinophilic Drug Allergy

Drug allergy

Allergy Diagnostic Testing in Clindamycin-Induced Skin Reactions

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