Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations

Aberer, Werner; Bircher, Andreas J.; Romano, Antonino; Blanca, Miguel; Campi, Paolo; Fernández, J.; Brockow, Knut; Pichler, Werner J.; Demoly, Pascal

doi:10.1034/j.1398-9995.2003.00279.x

Cited by 726 publications

(669 citation statements)

References 64 publications

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“…If there was no contraindication, 7,8,10 NSAID provocation test was performed to confirm or exclude the presence of hypersensitivity and to classify the reaction.…”

Section: Drug Provocation Testmentioning

confidence: 99%

“…10 The diagnostic workup included single-blind, placebo-controlled DPT if the reported symptoms were subjective or if the open DPT performed ended in an unclear result. Incremental doses of the drug were administrated at intervals of 30---60 min, stopping as soon as the first objective symptoms occurred or at the end of the intake of the defined doses of the protocol.…”

Section: Drug Provocation Testmentioning

confidence: 99%

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Non-steroidal anti-inflammatory drug hypersensitivity in children

Alves

Romeira

Abreu

et al. 2017

Allergologia et Immunopathologia

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Introduction: There are rather few publications about hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAID) in the paediatric age. In this study, we aimed to assess the frequency of confirmed NSAID hypersensitivity in children with a previous reported reaction to NSAID in order to investigate the role of the drug provocation test (DPT) in the diagnostic workup and to explore the factors associated with confirmed NSAID hypersensitivity. Methods: We conducted a retrospective analysis of the clinical files from every patient under 18 years old who attended two Portuguese paediatric allergy outpatient clinics, from January 2009 to August 2014, due to a suspected NSAID hypersensitivity. Results: We included 119 patients, with a median age of nine years (P 25 ---P 75 : 5---14). Ibuprofen was the commonest implicated NSAID in the patients' reports (n = 94---79%). After DPT, NSAID hypersensitivity was confirmed in nine (7.6%) patients, excluded in 93 (78.2%) and was inconclusive in 17 (14.3%). In the majority (n = 95---79.8%), the reaction occurred in the first 24 h after intake. Eighty-four patients (70.6%) reported only cutaneous manifestations and 18 (15.1%) had systemic symptoms. Anaphylaxis represented a relative risk to NSAID hypersensitivity confirmation. No association was found for atopy and the number of previous reactions. Conclusion: In our study, NSAID hypersensitivity was confirmed in a small proportion of the patients with a previous reported reaction. Ibuprofen was the most implicated drug with urticaria/angio-oedema as the commonest manifestation. Anaphylaxis was associated with confirmed drug hypersensitivity. The drug provocation test was essential to establish the diagnosis.

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“…If there was no contraindication, 7,8,10 NSAID provocation test was performed to confirm or exclude the presence of hypersensitivity and to classify the reaction.…”

Section: Drug Provocation Testmentioning

confidence: 99%

Section: Drug Provocation Testmentioning

confidence: 99%

Non-steroidal anti-inflammatory drug hypersensitivity in children

Alves

Romeira

Abreu

et al. 2017

Allergologia et Immunopathologia

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“…17 Patients' parents signed informed consent before the DPT. The DPT entails ingesting increasing doses of the antibiotic, every 30 min, until the appropriate cumulative dose per weight was reached.…”

Section: Drug Provocation Testsmentioning

confidence: 99%

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Chambel

Martins

Silva

et al. 2010

Allergologia et Immunopathologia

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Background: Few studies have been performed in children with suspected betalactam allergy. We aimed to assess the role of the drug provocation test (DPT) with betalactams in a paediatric setting and to study the association between allergy to betalactam antibiotics and other allergic diseases. Methods: We included all the patients under 15 years old who were consecutively referred to the Immunoallergy Department, Dona Estefânia Hospital, Portugal (January 2002 to April 2008) for a compatible history of allergic reaction to betalactam. All were submitted to a DPT. Children were proposed to perform skin tests (ST) to betalactam antibiotics followed by DPT. If they decline ST, a DPT with the culprit drug was performed. Results: We studied 161 children, 60% were boys, with a median age of 5 years old at the time of the DPT. Thirty-three patients (20.5%) had an immediate reaction and 33 (20.5%) a non-immediate reaction. The severity of the reported reactions was low in most cases. Skin tests to betalactams were performed in 47 children and were positive in 8. DPT was positive in only one (3.4%) of the patients skin tested and in 11 (13.4%) of those not skin tested. The severity of the DPT reaction was low. Asthma and food allergy were associated with a positive DPT in the later group. Conclusions: DPT seems a safe procedure even in the absence of ST in non-severe cases. This could be a practical option in infants and pre-school children, where ST are painful and difficult to perform. Additional caution should be taken in children with asthma and food allergy.

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“…In the case of severe reactions, such as the hypersensitivity syndrome, SJS, AGEP or TEN, the drug provocation test must be avoided (67).…”

Section: Provocation Testsmentioning

confidence: 99%

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Romano

Blanca

Torres

et al. 2004

Allergy

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323

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Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during β‐lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug‐specific T‐cell clones obtained from the circulating blood and the skin, suggest that a type‐IV (cell‐mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work‐up, the patient's history is fundamental; patch testing is useful, together with delayed‐reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug.Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to β‐lactams.

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Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations

Cited by 726 publications

References 64 publications

Non-steroidal anti-inflammatory drug hypersensitivity in children

Non-steroidal anti-inflammatory drug hypersensitivity in children

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

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