Patch testing in cutaneous reactions caused by carbamazepine

Abstract

The usefulness of patch testing in the diagnosis of carbamazepine-induced allergic skin eruptions was studied in 18 patients with previous histories of skin eruptions caused by carbamazepine. The etiological role of carbamazepine was ascertained by peroral or topical provocation in 15 (out of 18) patients. The clinical reactions caused by the drug were classified as maculopapular exanthema with general symptoms (7 patients), other type of exanthema (3), exfoliative dermatitis (erythroderma) (3), fixed drug eruption (3), erythema multiforme (1) and urticaria (1). Patch testing showed positive reactions to carbamazepine in 7 patients; in addition, 2 patients had doubtful reactions. Positive patch test reactions were seen only in patients with exfoliative dermatitis (all 3 patients) and maculopapular exanthema (4 out of 7). None of the patients with fixed drug eruption, erythema multiforme or urticaria, or the control subjects, had positive patch test reactions to carbamazepine. The present study suggests that patch testing is useful in the diagnosis of carbamazepine allergy in patients with maculopapular eruptions or erythrodermas.

Characterization of Clopidogrel Hypersensitivity Reactions and Management With Oral Steroids Without Clopidogrel Discontinuation

“…Drug allergy testing with skin prick and intradermal challenge has been standardized for several drugs responsible for immediate hypersensitivity reactions, but the use of patch testing as a means of controlled rechallenge in patients with delayedonset drug hypersensitivity is not widely used. However, recent reports have described the successful use of patch testing in the diagnosis of delayed hypersensitivity reactions to antibiotics (33), anticonvulsants (34), and antiretroviral agents (35). In the present study, patch testing was abnormal in 81% of tested patients with clopidogrel hypersensitivity.…”

Drug patch testing in systemic cutaneous drug allergy

“…The most frequent reports of positive drug patch tests are related to the following drugs: betalactam antibiotics (Romano et al, 2002), especially amoxicillin (Barbaud et al, 1998b(Barbaud et al, , 2000Van Ketel, 1987, 1989;Bruynzeel et al, 1985;Romano et al, 1993Romano et al, , 1995Barbaud et al, 1997;Vega et al, 1991;Felix and Comaish, 1974), cotrimoxazole (Klein et al, 1995), corticosteroids (Barbaud et al, 1998b;Dooms-Goossens, 1995;Bircher et al, 1996;Kilpio and Hannuksela, 2003), heparin derivatives (Barbaud et al, 1998b;Bircher et al, 1990;Moreau et al, 1996;Figarella et al, 2001), pristinamycin (Barbaud et al, 1998bMichel et al, 1996), carbamazepine (Barbaud et al, 1998b(Barbaud et al, , 2000Vaillant et al, 1989;Silva et al, 1982;Camarasa, 1985;Romaguera et al, 1989;Jones et al, 1994;Rodriguez-Mosquera et al, 1991;Alanko, 1993;Corazza et al, 1995;Puig et al, 1996), diltiazem (Barbaud et al, 1998a(Barbaud et al, , 1993Romano et al, 1992;Cholez et al, 2003), hydroxyzine (Barbaud et al, 1998b;Michel et al, 1997), pseudoephedrine …”

Hypersensitivity to Aromatic Anticonvulsants: In Vivo and In Vitro Cross-Reactivity Studies

“…However, there are few studies carried out with patch tests and/or LTTs on samples of at least 10 subjects with adverse reactions to anticonvulsants [10,[19][20][21][22][23], and all but one [20] refer only to carbamazepine. In these studies, excluding the one by Osawa et al [20], the percentage of positive responses to patch tests ranged from 19.7% (12 of 61 patients) [10] to 53.8% (7 of 13) [23]; when metabolites of carbamazepine were also used in patch testing, the frequency of positive responses increased to 55% and 69.2%, respectively [10,23].…”