Survey of Drug Allergy Testing, Challenge, and Desensitization Practice

Abstract

Background: The lack of standardized skin test products to determine a patient's (hyper-) sensitivity to medications has required physicians to empirically develop their own testing procedures. These approaches include puncture and intradermal skin tests, patch tests and medication challenges. Desensitization protocols are also frequently used when the necessity of a particular medication is urgent. Objective: This study surveyed drug hypersensitivity testing and desensitization practices reported in 3 allergy journals, over a 5-year period 2004-2008. Methods: This survey collected reports of skin tests, challenges, and desensitization to medications, vaccines, and diagnostic agents in 3 leading allergy journals. Studies were included if they reported sufficient detail that the reader could reasonably be expected to reproduce the technique reported. We did not include reports of in vitro testing because the ability of the individual practitioner to perform these tests may be limited. Results: Data for 191 drugs were sufficiently detailed to include. Testing with antimicrobial agents was reported most frequently; and several newer classes of medications such as monoclonal antibodies and interferons are also included. Skin testing to detect medication allergy was the most commonly reported technique; however there were numerous drug challenge and drug desensitization schedules used in practice. Conclusion: Beyond testing for medications such as antibiotics, corticosteroids and local anesthetics skin testing, challenge, and desensitization schedules have been described for numerous other medication classes. The variety of these schedules is likely driven both by the needs of clinical practice and the lack of standardized skin test preparations.