Article

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions: Proposed by the Working party of the ESCD for the study of skin testing in investigating cutaneous adverse drug reactions

University of Amsterdam, Amsterdamo, North Holland, Netherlands
Contact Dermatitis (Impact Factor: 3.62). 12/2001; 45(6). DOI: 10.1034/j.1600-0536.2001.450601.x

ABSTRACT 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.

Download full-text

Full-text

Available from: Margarida Gonçalo, Jul 08, 2015
0 Followers
 · 
42 Views
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Hypersensitivity reactions (HR) to para- cetamol are reported less commonly compared to other nonsteroidal antiinflammatory (NSAI) drugs. The aim of this study was to determine the rate of HR to paracetamol and paracetamol-propyphena- zone combination (P-P) drugs in patients with anal- gesic intolerance and to assess the possible relations between HR to these drugs and other NSAI drugs as well as atopic diseases.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Les tests cutanés médicamenteux peuvent être utiles dans l'exploration de certaines toxidermies immunoallergiques. Leur standardisaion pour une homogénéisation de la prise en charge des patients dans es services de dermatologie européens est en cours. Les tests utilisés sont de trois grands types explorant chacun des mécanismes immunologiques différents. Les tests épicutanés (patch tests:PT) explorent l'hypersensibilité cellulaire retardée,les prick tests mesurent l'hypersensibilité immédiate et les tests intradermiques (IDR),réalisés en cas de négativité des autres tests, évaluent l'hypersensibilité immédiate mais aussi cellulaire retardée. Les mécanismes des toxidermies sont mal connus. Les résultats des tests cutanés médicamenteux dépendent du médicament en cause et du mécanisme de la toxidermie en cause. Parmi 164 patients dans lesquelles un seul médicament avait une forte imputabilité, qui ont eu des PT médicamenteux et en cas de négativité des prick tests puis des IDR, 72% ont eu au moins un test positif. Certaines urticaires sont dues à une hypersensibilité immédiate IgE dépendante,les prick tests puis IDR avec dilutions progressives peuvent avoir des résultats immédiats positifs. Les vasculites sont dues à des complexes immuns circulants, les tests cutanés médicamenteux sont négatifs dans leur exploration. Une hypersensibilité cellulaire retardée est en cause dans le déclenchement des exanthèmes maculo-papuleux, syndrome Babouin , eczéma localisé au point d'injection ou généralisé, pustulose exanthématique aiguë généralisée. Dans ces toxidermies, les PT et IDR lues à au moins 24 heures, sont positifs chez plus de 50% des patients. Dans les ?drug rash with eosinophilia and systemic symptoms?, les patch tests réalisés àfaible concentration sont intéressants. Les syndromes de Stevens - Johnson et de Lyell relèvent de mécanismes complexes toxiques et immunologiques mal reproduits par les tests cutanés médicamenteux.
    Thérapie 12/2001; 57(3):258-262. · 0.40 Impact Factor