Predicting which medication classes interfere with allergy skin testing

Abstract

Medications often interfere with allergy skin test interpretation. This study was performed to determine which medications interfere with allergy skin tests. We retrospectively reviewed skin-prick test results from patients who had discontinued H(1)-antagonists, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, atypical antidepressants, antipsychotics, hypnotics, sedatives, proton pump inhibitors (PPIs), and H(2)-antagonists between 0 and 7 days before allergy skin testing. Ninety-seven subjects had taken second-generation H(1)-antihistamines within 7 days of skin testing; all patients who had stopped 3 days before testing had positive histamine controls. Two hundred sixty-eight skin tests performed on patients taking a single medication of interest showed that patients had the following percentages of a positive histamine control: TCAs, 56.5%; SNRIs, 100%; H(2)-blockers, 100%; SSRIs, 97%; PPIs, 97%; benzodiazepines, 85.7%; and atypical antidepressants/sedatives, 92.6%. The 580 patients taking multiple medications of interest showed that the odds ratio and 95% confidence intervals of a negative histamine test for patients taking TCAs were 6.33 (2.11-20.5), for H(1)-blockers were 4.95 (1.78-15.1), for benzodiazepines were 5.01 (1.72-15.80), for atypical antidepressants/sedatives were 3.11 (1.09-9.61), and for H(2)-blockers were 2.91 (0.97-9.37). The odds of a negative histamine test for SSRIs, SNRIs, or PPIs were not significantly increased. SSRIs, SNRIs, and PPIs are unlikely to interfere with skin testing. TCAs, H(1)-blockers, benzodiazepines, quetiapine, and mirtazapine should be discontinued temporarily if clinically able. H(2)-antagonists, bupropion, eszopiclone, trazodone, or zolpidem showed minimal interference with immediate hypersensitivity skin test histamine response.

Diagnostics in Hymenoptera venom allergy: current concepts and developments with special focus on molecular allergy diagnostics

“…The use of medications such as corticosteroids, antihistamines, and antihistaminergic antipsychotics can suppress skin test responsiveness and give rise to false negative results. Table 3 lists medications that should be discontinued prior to skin testing, adapted from reviews [24, 25]. …”

“…Table 3 lists medications that should be discontinued prior to skin testing, adapted from reviews [24, 25]. …”

Debates in allergy medicine: Molecular allergy diagnosis with ISAC will replace screenings by skin prick test in the future

“…However, what is much more important in clinics is that the intake of numerous medications may interfere with skin prick reactivity. This was recently analysed in detail in a large retrospective study [ 30 ]. Tricyclic antidepressants, benzodiazepines, quetiapine, and mirtazapine should be discontinued 1 week before testing, H(1)-blockers 3 days [ 30 ].…”

“…This was recently analysed in detail in a large retrospective study [ 30 ]. Tricyclic antidepressants, benzodiazepines, quetiapine, and mirtazapine should be discontinued 1 week before testing, H(1)-blockers 3 days [ 30 ]. The risk for a negative histamine test was not elevated for selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors and proton pump inhibitors [ 30 ].…”

Prevalence of Inhalant and Food Allergies after Skin Prick Testing in Patients with Resistant Allergic Rhinitis in Warm Humid Weather

“…Antihistaminedependent patients can be subjected to test only after 36 hours of last antihistamine dose 3 . Tricyclic antidepressants are also known to inhibit the response 10 .…”