Usefulness of intradermal test and patch test in the diagnosis of nonimmediate reactions to metamizol

Macías, Eva; Ruiz, Adolfo Romero; Moreno, Esther; Laffond, Elena; Dávila, Ignacio; Lorente, F.

doi:10.1111/j.1398-9995.2007.01487.x

Cited by 22 publications

(19 citation statements)

References 13 publications

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“…The occurrence of a positive patch test reaction to metamizole exclusively in suspected cases, namely 2 with a positive re‐exposure and 2 with histopathology compatible with a T cell‐mediated reaction, shows that metamizole can be involved in non‐immediate CADRs. Thus, patch testing can be considered to be an important tool with which to investigate these reactions, as shown in a previous study showing positive patch test reactions to metamizole in 4 of 11 (36%) patients with non‐severe non‐immediate CADRs . In our series, patch testing was also useful for confirming drug imputability in 3 of 4 (75%) patients with severe CADRs, such as DRESS or SJS.…”

Section: Discussionsupporting

confidence: 68%

Patch testing in the investigation of non‐immediate cutaneous adverse drug reactions to metamizole

2017

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Section: Discussionsupporting

confidence: 68%

Patch testing in the investigation of non‐immediate cutaneous adverse drug reactions to metamizole

2017

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“…All NSAIDs can cause NIHR, and these can be detected by positive patch tests (high/strong) . The relative incidence of allergic and nonallergic reactions is not well studied (moderate/weak).…”

Section: Resultsmentioning

confidence: 99%

Skin test concentrations for systemically administered drugs – anENDA/EAACIDrug Allergy Interest Group position paper

Brockow

Garvey

Aberer

et al. 2013

Allergy

748

598

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Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.

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“…There are only a few experimental studies on the quantification of IgE antibodies, and no detailed studies have been carried out in this field [8,9,10]. For delayed reactions, positive delayed ID and/or patch tests to the culprit drug with a characteristic T-cell infiltrate have been reported [6,34,35,36,37,38]. Further evidence has been provided by in vitro cellular assays [38,39].…”

Section: Discussionmentioning

confidence: 99%

Allergic Reactions to Metamizole: Immediate and Delayed Responses

Blanca‐López

Pérez‐Sánchez²,

Agúndez³

et al. 2016

Int Arch Allergy Immunol

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Background: Pyrazolones are the most common causes of selective nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We studied a large group of patients with immediate and delayed selective responses to metamizole. Methods: Patients with suspicion of hypersensitivity to metamizole were evaluated. We verified acetylsalicylic acid tolerance and classified patients as immediate or delayed responders if they showed symptoms less or more than 24 h after metamizole administration. Skin tests were performed and if negative, a basophil activation test (BAT) was performed on immediate responders. If it was negative, we performed a drug provocation test (DPT) with metamizole. Results: A total of 137 patients were included: 132 reacted within 24 h (single NSAID-induced urticaria/angioedema/anaphylaxis; SNIUAA) and 5 after 24 h (single NSAID-induced delayed hypersensitivity reaction; SNIDHR). Most SNIUAA patients developed anaphylaxis (60.60%); for SNIDHR, maculopapular exanthema was the most frequent entity (60%). Skin testing was positive in 62.04% of all cases and BAT in 28% of the SNIUAA patients with negative skin tests. In 5.1% of the cases, DPT with metamizole was needed to establish the diagnosis. In 22.62% of the cases, diagnosis was established by consistent and unequivocal history of repeated allergic episodes in spite of a negative skin test and BAT. Conclusions: SNIUAA to metamizole is the most frequent type of selective NSAID hypersensitivity, with anaphylaxis being the most common clinical entity. It may occur within 1 h after drug intake. SNIDHR occurs in a very low percentage of cases. The low sensitivity of diagnostic tests may be due to incomplete characterization of the chemical structures of metamizole and its metabolites.

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Usefulness of intradermal test and patch test in the diagnosis of nonimmediate reactions to metamizol

Cited by 22 publications

References 13 publications

Patch testing in the investigation of non‐immediate cutaneous adverse drug reactions to metamizole

Patch testing in the investigation of non‐immediate cutaneous adverse drug reactions to metamizole

Skin test concentrations for systemically administered drugs – anENDA/EAACIDrug Allergy Interest Group position paper

Allergic Reactions to Metamizole: Immediate and Delayed Responses

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