Evaluation of Skin Test Reactions in Patients with Non‐immediate Type Drug Eruptions

Osawa, Junko; Naito, Shizuo; Aihara, Michiko; Kitamura, Kazuko; Ikezawa, Zenrō; Nakajima, Hiroshi

doi:10.1111/j.1346-8138.1990.tb01631.x

Cited by 97 publications

(68 citation statements)

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“…Even when performed according to reviewed guidelines, skin testing is negative in 30-50% of patients (1)(2)(3)5). Negative results may have several explanations: the final responsible agent for the CADR is a drug metabolite that is not formed in the skin when the native drug is applied there; there is no immune mechanism involved in the CADR; or concomitant factors that are responsible in inducing a transient oral drug intolerance, such as a viral infection, are not present at the time of testing.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…Among these 3 different skin test procedures, patch testing is the one most extensively studied in CADRs. In patients with a high imputability of one drug in the onset of their CADR, drug patch tests had positive results in 43% of 72 patients (1), 50% of 108 patients (2), 43.9% of 66 patients (5), and 31.7% of 197 patients (3). Positive relevant results depend on the clinico-evolutive type of CADR, on the respon-sible drug, on the drug concentration and vehicle used (1,2,5), and even on the skin sites where tests are performed (8,11,12,(15)(16)(17).…”

Section: Commentmentioning

confidence: 99%

“…Skin testing (patch testing and also prick and intradermal (IDT) testing), with the suspected compound, has been reported to be helpful in determining the cause of a CADR (1)(2)(3)(4)(5) and in studying the pathophysiological mechanisms involved in these reactions. According to previous data, the results of drug skin tests mainly depend on the drug tested and the clinical features of the initial CADR (1, 2, 4-6), but there are, at present, a few extensive studies that determine the sensitivity and specificity of these drug skin tests as a complementary tool for drug imputability in CADR.…”

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confidence: 99%

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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: Interpretation Of Resultsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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

et al. 2001

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“…Generally, intradermal testing appears to be somewhat more sensitive than patch testing (27,28,30,(36)(37)(38)(41)(42)(43). In some studies, subjects with delayed intradermal test positivity and patch test negativity were challenged with positive responses in six of nine patients (30,37,42).…”

Section: Sensitivity and Specificitymentioning

confidence: 99%

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Romano

Blanca

Torres

et al. 2004

Allergy

320

368

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Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during β‐lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug‐specific T‐cell clones obtained from the circulating blood and the skin, suggest that a type‐IV (cell‐mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work‐up, the patient's history is fundamental; patch testing is useful, together with delayed‐reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug.Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to β‐lactams.

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“…Moreover, since 1966 there have been studies suggesting that the delayed reading of intradermal skin tests and/or patch tests can be an effective way of diagnosing nonimmediate allergic reactions to systemically administered β-lactams, such as maculopapular and urticarial rashes [1, 2, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29]. In some cases, challenges with suspect β-lactams have confirmed allergologic test positivity [2, 20, 23, 24, 25, 26, 29].…”

Section: Introductionmentioning

confidence: 99%

Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

Romano

Viola

Mondino

et al. 2002

Int Arch Allergy Immunol

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Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1% of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2%). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients – 93 of whom had experienced maculopapular rashes – displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.

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Evaluation of Skin Test Reactions in Patients with Non‐immediate Type Drug Eruptions

Cited by 97 publications

References 4 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

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

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