Penicillin Allergy and the Relevance of Epicutaneous Tests

Bruynzeel, Derk P.; Flier, Mary von Blomberg-van der; Scheper, R.J.; Ketel, W. G. van; Haan, Peter

doi:10.1159/000249468

Cited by 29 publications

(13 citation statements)

References 9 publications

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“…The most frequent reports of positive drug patch tests are related to the following drugs: betalactam antibiotics, especially amoxicillin (1,2,4,6,18,(24)(25)(26)(27)(28)(29)(30), cotrimoxazole (15), corticosteroids (1,31,32), heparin derivatives (1,(33)(34)(35)(36), pristinamycin (1,36), carbamazepine (1,2,20,(37)(38)(39)(40)(41)(42)(43)(44), diltiazem (1,45,46), diazepam (47), hydroxyzine (1,48), pseudoephedrine (1,21,22) and tetrazepam (1,16,(49)(50)(51).…”

Section: Commentmentioning

confidence: 99%

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

et al. 2001

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Skin testing with a suspected drug has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADR). Many isolated reports of positive drug skin tests are published, but without detailed information concerning the clinical features of the CADR and the method used in performing drug skin tests, such data are not very informative. A working party of the European Society of Contact Dermatitis (ESCD) for the study of skin testing in investigating cutaneous adverse drug reactions, has proposed the herein-reported guidelines for performing skin testing in CADR in order to standardize these procedures. In each reported case, the imputability of each drug taken at the onset of the CADR and a highly detailed description and characterization of the dermatitis need to be given. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed according to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested diluted at 30% pet. (pet.) and/or water (aq.). The pure drug is tested diluted at 10% in pet. or aq. In severe CADR, drug patch tests are performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR. Drug prick tests are performed on the volar forearm skin with the commercialized form of the drug, but with sequential dilutions in cases of urticaria. Intradermal tests (IDT) are performed with sterile sequential dilutions (10-4, 10-3, 10-2, 10-1) of a pure sterile or an injectable form of the suspected drug with a small volume of 0.04 ml. Drug skin tests need to be read at 20 min and also later at D2 and D4 for patch tests, at D1 for prick tests and IDT. All these tests also need to be read at 1 week. The success of skin tests varies with the drug tested, with a high % of positive results, for example, with betalactam antibiotics, pristinamycin, carbamazepine and tetrazepam on patch testing, or with betalactam antibiotics and heparins on delayed readings of IDT. The results of drug skin tests also depend on the clinical features of the CADR. The use of appropriate control patients is necessary to avoid false-positive results.

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Section: Commentmentioning

confidence: 99%

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

et al. 2001

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“…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 …”

Section: The Clinical Significance Of Drug Patch Testsmentioning

confidence: 99%

“…Patch testing with the suspected compound has been reported to be helpful in determining the cause of a CADR (Barbaud et al, 2001a(Barbaud et al, , 1998b(Barbaud et al, , 2000Osawa et al, 1990;Van Ketel, 1987, 1989;Barbaud, 2002Barbaud, , 2003Bruynzeel et al, 1985;Romano et al, 1993) and in studying the pathophysiological mechanisms involved in these reactions. The results of drug patch tests depend on the drug tested and the clinical features of the initial CADR (Barbaud et al, 1998b;Osawa et al, 1990;Bruynzeel and Van Ketel, 1987).…”

Section: Introductionmentioning

confidence: 99%

Drug patch testing in systemic cutaneous drug allergy

Barbaud

2005

Toxicology

124

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“…However, as we and others have shown, patch tests can be helpful for the aetiological diagnosis. [5][6][7][8][9][10][11][12][13][14][15] Osawa et al 14 have reported positive drug patch test results in 31·5% of cutaneous ADRs of nonimmediate type. More specifically, the positivity rates reported in the literature vary between 17% and 35% in investigated cutaneous ADRs caused by penicillin derivatives.…”

mentioning

confidence: 99%

“…More specifically, the positivity rates reported in the literature vary between 17% and 35% in investigated cutaneous ADRs caused by penicillin derivatives. 8,11 In spite of the interest of such investigations, the literature lacks prospective studies determining the value and specificity of drug skin tests in cases of cutaneous ADRs. Guidelines are also lacking concerning the procedure to use for each drug and the various clinical forms of cutaneous ADRs.…”

mentioning

confidence: 99%

The use of skin testing in the investigation of cutaneous adverse drug reactions

Barbaud¹,

Reichert-Pénétrat²,

Tréchot³

et al. 1998

Br J Dermatol

236

204

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Skin testing with the suspected compound has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (ADRs), but the value and specificity of these tests need to be determined. In this study, 72 patients with presumed drug eruptions (27 maculopapular, 18 urticarial, seven erythrodermic, nine eczematous, four photosensitivity, three fixed drug eruptions, three with pruritus and one with acute generalized exanthematous pustulosis) were assessed. All had drug patch tests; 46 also had prick tests and 30 had intradermal tests (performed on hospitalized patients using a sterile solution of the suspected drug, diluted sequentially) with immediate and delayed readings. Among these patients, 52 (72%) had a positive skin test reaction, 43%, 24% and 67% in patch, prick and intradermal skin tests, respectively. The results of skin tests varied with the drug tested and with the clinical type of cutaneous ADR, as a significantly higher number of positive patch tests was observed in maculopapular rashes than in urticarial reactions (P = 0.001). This study supports the value of careful sequential drug skin testing in establishing the cause of cutaneous ADR. Guidelines are proposed for performing these tests, and these include the use of appropriate negative control patients to avoid false-positive results.

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Penicillin Allergy and the Relevance of Epicutaneous Tests

Cited by 29 publications

References 9 publications

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

Drug patch testing in systemic cutaneous drug allergy

The use of skin testing in the investigation of cutaneous adverse drug reactions

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