Drug provocation tests in hypersensitivity drug reactions

Abstract

DPT is often needed when evaluating patients with suspected drug HSR. More studies regarding standardization of the various protocols are needed in order to increase its acceptance and adoption as a standard practice in the diagnostic algorithm for drug HSR.

Prevalence of confirmed immediate type drug hypersensitivity reactions among school children

“…Only three patients had a positive skin prick test, while one patient with a negative result tested positive following drug provocation. Based on these results, it is recommended that patients with a negative skin prick test and undetectable titers of specific IgE should be subjected to a drug provocation test as a gold standard, barring any contraindication .…”

Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis

“…In regard to the per‐patient recurrence rate of HSRs after challenge of skin test‐negative ICM, it was considered to be tolerable when the reaction did not occur either to full‐dose challenge to ICM or to graded challenge/drug provocation test without premedication . In patients undergoing multiple challenges to different skin test‐negative ICM, the patient was regarded tolerant only when all challenged ICM did not cause a reaction.…”

Antimicrobial stewardshipʼs new weapon? A review of antibiotic allergy and pathways to ‘de-labeling’

“…For most antibiotic classes other than β-lactams, the NPV value of SPT/IDT falls significantly short of 100% and oral challenge provides more definitive information regarding drug safety [10 ▪▪ ]. In appropriately selected patients, oral re-challenge has a high NPV (94–100%) for immediate/IgE-mediated β-lactam allergies [75,76]. However, a single dose oral challenge will not rule out a delayed T-cell-mediated reaction, which requires repeat or extended dosing challenges.…”