DRESS and AGEP Reactions to Iodinated Contrast Media: A French Case Series

Soria, Angèle; Amsler, E.; Bernier, C.; Milpied, B.; Tétart, F.; Morice, C.; Dezoteux, F.; Bouëdec, Marie-Christine Ferrier-Le; Barbaud, A.; Staumont‐Sallé, D.; Assier, Haudrey

doi:10.1016/j.jaip.2021.02.060

Cited by 27 publications

(16 citation statements)

References 36 publications

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“…Because of the high sensitivity of testing carbamazepine and amoxicillin, classes of drugs having high scores of positive patch tests are antiepileptic drugs and beta‐lactam antibiotics, whereas the fluoroquinolone antibiotics are rarely positive 58 . In one study, 10 out of 12 patients (83%) with DRESS from iodinated contrast media had positive patch tests, but these results may have been biased by selecting patients on the basis of a positive skin or challenge test 61 …”

Section: Results Of Literature Reviewmentioning

confidence: 99%

“…58 In one study, 10 out of 12 patients (83%) with DRESS from iodinated contrast media had positive patch tests, but these results may have been biased by selecting patients on the basis of a positive skin or challenge test. 61 From these data it follows that, in groups of patients with DRESS (from various drugs), the percentage of positive reactions may be heavily influenced by the nature of the culprit drugs. In groups in which the drugs tested were specified, the sensitivity ranged from 32% to 64%.…”

Section: Sensitivity Of Patch Testing In Patients With Dressmentioning

confidence: 99%

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Patch testing in drug reaction with eosinophilia and systemic symptoms (DRESS): A literature review

Groot

2022

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The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. One hundred and five drugs were identified that have together caused 536 positive patch tests in 437 DRESS patients. By far, the most reactions (n = 145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions were anticonvulsants (39%), beta‐lactam antibiotics (20%), antituberculosis agents (11%), non‐beta‐lactam antibiotics (6%), and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta‐lactam antibiotics (notably amoxicillin), and, possibly, iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing.

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Section: Results Of Literature Reviewmentioning

confidence: 99%

Section: Sensitivity Of Patch Testing In Patients With Dressmentioning

confidence: 99%

Patch testing in drug reaction with eosinophilia and systemic symptoms (DRESS): A literature review

Groot

2022

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“…Some drugs de Groot • Patch Testing in Drug Eruptions are frequently patch test positive, for example, carbamazepine and some other antiepileptics, 12,50,51 pristinamycin, 52 aminopenicillins, 53 and iodinated contrast media. 12,54 Others, however, give infrequently or hardly ever positive patch tests, including allopurinol. A possible explanation is that the sensitizers are not the drugs themselves, but metabolites, which are not formed in the skin during patch testing.…”

Section: Sensitivitymentioning

confidence: 99%

Patch Testing in Drug Eruptions: Practical Aspects and Literature Review of Eruptions and Culprit Drugs

Groot¹

2022

Dermatitis

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There is overwhelming evidence that many delayed cutaneous adverse drug reactions (beginning >6 hours after drug intake) are mediated by delayed-type (type IV) hypersensitivity, including maculopapular eruptions, erythroderma, symmetrical drug-related intertriginous and flexural exanthema/baboon syndrome, eczematous eruptions, fixed drug eruptions, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome. Therefore, after resolution of the reaction, patch tests should be performed as first diagnostic method to identify the culprit drug(s). This article provides tools to perform drug patch tests properly and safely, discussing clinical history, indications, procedure, drug patch test materials, sensitivity, the meaning of negative patch tests, and safety of the procedure. In addition, a literature review of eruptions and culprit drugs is provided in tabular format.

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“…3,4 Intradermal tests (IDTs) have been mainly used to explore immediate drug hypersensitivity and maculopapular rash and more recently other NICADRs. [5][6][7][8][9][10][11][12][13] International consensus is still lacking for STs: in the United States, STs are not routinely performed, but published European guidelines recommend PTs with two readings followed by IDTs. 2,6,14,15 These readings typically take place on day 2 (D2) and D4.…”

Section: Introductionmentioning

confidence: 99%

“…Patch tests (PTs) were the first STs used, with valuable and safe results, to investigate severe and non‐severe NICADRs 3,4 . Intradermal tests (IDTs) have been mainly used to explore immediate drug hypersensitivity and maculopapular rash and more recently other NICADRs 5‐13 . International consensus is still lacking for STs: in the United States, STs are not routinely performed, but published European guidelines recommend PTs with two readings followed by IDTs 2,6,14,15 .…”

Section: Introductionmentioning

confidence: 99%

Patch tests in nonimmediate cutaneous adverse drug reactions: The importance of late readings on day 4

Bhujoo¹,

Ingen‐Housz‐Oro

Géner³

et al. 2021

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Background: Patch tests (PTs) with two readings have been used for decades to identify the culprit drug in nonimmediate cutaneous adverse drug reactions (NICADRs), followed more recently by late reading of intradermal tests (IDTs). Some teams tend to perform PTs with only one reading before IDTs or even directly perform IDTs.Objectives: To evaluate the relevance of a late PT reading on day 4 (D4) in NICADRs.Methods: We retrospectively selected patients who had a PT for an NICADR between July 2014 and March 2020.Results: During the study period, 328 patients had a PT with available results.Among the 75 positive-PT patients with available data for the two readings, 41 (54.7%) had positive results on D2 and D4 and 34 (45.3%) had negative results on D2 but positive results on D4. No patient had positive results on D2 and negative results on D4. Conclusion:This study shows that a D4 reading enhanced the PT-positive results. A positive PT result allows for reducing the number of IDTs, which are more difficult and costly to perform. Our series suggests that a late PT reading at D4 should be performed for exploring NICADRs.

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DRESS and AGEP Reactions to Iodinated Contrast Media: A French Case Series

Cited by 27 publications

References 36 publications

Patch testing in drug reaction with eosinophilia and systemic symptoms (DRESS): A literature review

Patch testing in drug reaction with eosinophilia and systemic symptoms (DRESS): A literature review

Patch Testing in Drug Eruptions: Practical Aspects and Literature Review of Eruptions and Culprit Drugs

Patch tests in nonimmediate cutaneous adverse drug reactions: The importance of late readings on day 4

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