Value of patch tests in clindamycin-related drug eruptions

Abstract

SummaryBackground. Patch tests help to confirm the aetiology of the cutaneous adverse drug reactions involving delayed hypersensitivity mechanisms, but the results vary with the pattern of skin reaction and the culprit drug. Objectives. To analyse the results of patch tests in patients with cutaneous adverse drug reactions imputable to clindamycin and assess their contribution to the diagnosis. Patients and methods. Between 2005 and 2009, we studied patients with delayed cutaneous adverse drug reactions following administration of clindamycin, usually associated with other drugs. After resolution of the cutaneous adverse drug reaction, patch tests were performed with a series of antibiotics, including pure clindamycin 10% in petrolatum. Results. We studied 30 patients (23 females and 7 males) aged 33-86 years (mean 59.97 years) with generalized maculopapular exanthema where clindamycin was among the highly suspected drugs. Two patients had a previous positive involuntary rechallenge. Patch tests with clindamycin were positive in 9 of 30 patients (30%). More than 50 control patients patch tested with clindamycin were negative. Discussion. We considered the positive patch tests results with clindamycin, in the 9 patients with maculopapular exantema, to be specific, versus the negative results observed in the control group. Although the sensitivity is low (30%), they confirmed the responsibility of this antibiotic in cutaneous adverse drug reactions in which, with only chronological criteria, it was not possible to conclude on the culprit drug.

The 3 Cs of Antibiotic Allergy—Classification, Cross-Reactivity, and Collaboration

“…Whilst IDT may be associated with an increased risk of systemic events, 93, 94 patch testing (PT) in severe cutaneous adverse reactions (SCAR) is considered safe. 95–98 Guidelines suggest IDT can be performed, only after a negative PT and at least 6 weeks post skin healing. 99 …”

Reações Cutâneas de Hipersensibilidade Retardada a Medicamentos: Serão os Testes Epicutâneos Positivos Persistentes?

“…24,25 Em relação à carbamazepina demonstrámos que nos cinco casos de DRESS, a hipersensibilidade retardada ao anticonvulsivante se manteve positiva, após um tempo mediano de 12,0 anos. A reprodutibilidade destes testes tem sido apenas descrita de forma esporádica, em alguns relatos de caso, AMX -amoxicilina; AMP -ampicilina; TE -testes epicutâneos; *sem diferença estatisticamente significativa em relação ao género (p= 0,6, teste qui--quadrado), idade (p = 0,9, teste Kruskal-Wallis) ou intervalo entre testes (p = 0,1, teste Kruskal-Wallis)…”

Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity

“…In recent studies, IDT has been suggested to be more sensitive than patch testing (PT) for T-cell-mediated ADRs [64]. However, in the setting of serious T-cell-mediated ADRs, PT is still considered “safer” than delayed-SPT/IDT [65,66]. The details of PT and IDT for T-cell-mediated ADRs are described below and a summary of T-cell-mediated ADRs is provided in Table 2.…”

“…The sensitivity of PT varies, however, and is highest for DRESS (32–80%) [112,113] and AGEP (58–64%) [112,114], and lowest for SJS/TEN (9–24%) [112,114] and MPE (10–40%) [65,113]. Patch testing lacks an appropriate positive control and results may be difficult to interpret in patients who are on immunosuppressants that impact T-cell-mediated immunity.…”

“… References: [5,9,39,65,69,73–111] Abbreviations : T-cell-mediated ADRs, delayed hypersensitivity reactions; SJS, Stevens-Johnson Syndrome; TEN, toxic epidermal necrolysis; DRESS, drug reaction with eosinophilia and systemic symptoms; AGEP, acute generalised exanthematous pustolosis; EM, erythema multiforme; FDE, fixed drug eruption; Linear IgA, linear immunoglobulin IgA disease; MPE, maculopapular examthem; TMP-SMX, trimethoprim-sulfamethoxazole; ADF, amoxicillin-clavulanate; LTT, lymphocyte transformation test; ELISpot, enzyme-linked immunospot assay; BSA, body surface area. a Much shorter duration for antibiotics than other drugs (1 vs. 11) b Can be as early as 48 hours on drug re-exposure, median time 14 days c Can be as short as 30 mins to 8 hours post drug administration [69] d Latency periods are rarely up to 30 days. e Nikolsky sign – The ability to extend the area of sloughing with the application of gentle lateral pressure on seemingly unaffected skin. Asboe- Hansen sign (“bullae spread”) – Lateral extension of bullae with gentle pressure…”