Patch testing in non‐immediate cutaneous adverse drug reactions: value of extemporaneous patch tests

Assier, Haudrey; Valeyrie‐Allanore, Laurence; Géner, G.; Carvalh, Muriel Verlinde; Chosidow, Olivier; Wolkenstein, Pierre

doi:10.1111/cod.12842

Cited by 30 publications

(24 citation statements)

References 32 publications

(35 reference statements)

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“…Our results confirm a PT sensitivity of about 30%, which is similar to previous reported series with this method in non‐immediate CADRs . Among the 22 patients who underwent P‐IDRs after a negative PT result, only two had a positive P‐IDR associated with a negative PT result.…”

Section: Discussionsupporting

confidence: 90%

“…Our results confirm a PT sensitivity of about 30%, which is similar to previous reported series with this method in non-immediate CADRs. [21][22][23]26 Among the 22 patients who underwent P-IDRs after a negative PT result, only two had a positive P-IDR associated with a negative PT result. So, in our opinion, PTs, which are the only tests recommended for DRESS and bullous CADRs, seem also sufficient for AGEP and for MPE with late delay of onset.…”

Section: Discussionmentioning

confidence: 99%

“…However, published studies of BL‐induced non‐immediate CADRs included heterogeneous patients and mainly ‘erythema’ ‘oedema’, urticaria and MPE without data on the delay of onset . In contrast, few studies included patients with precise or severe phenotypes of late CADRs …”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16][17][18][19][20] In contrast, few studies included patients with precise or severe phenotypes of late CADRs. [21][22][23] Cross-reactivity among BL is usually explored by skin tests, sometimes followed by rechallenges. 24 However, lack of consensus and standardization remains on how to explore different types of non-immediate CADRs.…”

Section: Introductionmentioning

confidence: 99%

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Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Bérot¹,

Géner²,

Ingen‐Housz‐Oro

et al. 2019

Acad Dermatol Venereol

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Background Cross‐reactivity among beta‐lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives To evaluate cross‐reactivity beyond BLs in patients with non‐immediate cutaneous adverse drug reaction (non‐immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods We conducted a retrospective single‐centre study in consecutive patients consulting between 2010 and 2018 with an active BL‐suspected non‐immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P‐IDR)] for at least three penicillin's subclasses and amino‐ and non‐amino‐cephalosporins (at least one aminocephalosporin). Cross‐reactivity among subclasses was investigated for patients with positive tests. Results We included 56 patients, among whom 46 amoxicillin‐suspected were and seven cephalosporin‐suspected. Twenty‐nine had severe CADR, and 27 had non‐immediate maculopapular exanthema (MPE). Twenty‐two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin‐suspected, 10 (55.6%) showed cross‐reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non‐aminocephalosporin. No amoxicillin‐ or cephalosporin‐suspected patient showed cross‐reactivity with aztreonam or carbapenems. P‐IDR showed cross‐reactivity only once. Conclusion After a suspected BL‐induced non‐immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross‐reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross‐reactivity was frequent and PT was sufficient to this purpose. The frequent cross‐reactivity among penicillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross‐allergies are rarer.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Bérot¹,

Géner²,

Ingen‐Housz‐Oro

et al. 2019

Acad Dermatol Venereol

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“…When the active ingredient is available in pure form (eg, lyophilized), it is recommended to dilute it at 10% in petrolatum (high/strong); otherwise, the powder contained in capsules, or obtained by removing the external layer of tablets with a scalpel and crushing them in a mortar, can be diluted at 20% or 30% in petrolatum …”

Section: Diagnosismentioning

confidence: 99%

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Romano

Atanasković-Marković

Barbaud

et al. 2020

Allergy

251

373

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A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with betalactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost-effective, as pos-Mono

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Patch Testing in Adverse Drug Reactions

Gonçalo

Bruynzeel²

2020

Contact Dermatitis

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Patch testing in non‐immediate cutaneous adverse drug reactions: value of extemporaneous patch tests

Cited by 30 publications

References 32 publications

Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Cross‐reactivity in beta‐lactams after a non‐immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Towards a more precise diagnosis of hypersensitivity to beta‐lactams — an EAACI position paper

Patch Testing in Adverse Drug Reactions

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