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

Contact Dermatitis - Tập 45 Số 6 - Trang 321-328 - 2001
A. Barbaud1, Margarida Gonçalo2, Derk P. Bruynzeel3, Andreas J. Bircher4
1Dermatology Department, Hopital Fournier, 54000 Nancy, France.
2Dermatology Department, Hospital da Universidade, 3000‐075 Coimbra, Portugal
3Department of Dermatology, Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
4Allergologische Poliklinik, Kantonsspital, Basel, Switzerland

Tóm tắt

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.

Từ khóa


Tài liệu tham khảo

10.1046/j.1365-2133.1998.02313.x

Barbaud A, 2000, Tests cutanés dans l'exploration des toxidermies supposées de mécanisme immuno‐allergique, Bull Acad Natle Med, 184, 47

10.1111/j.1346-8138.1990.tb01631.x

Bruynzeel D P, 1989, Patch testing in drug eruptions, Sem Dermatol, 8, 196

Gonçalo M, 2000, Epicutaneous patch testing in drug eruptions, Contact Dermatitis, 42, s22

Bruynzeel D P, 1987, Skin tests in the diagnosis of maculopapular drug eruptions, Sem Dermatol, 6, 119

10.1016/S0140-6736(85)90918-3

10.3109/09546639909056032

Wilkinson D S, 1970, Terminology of contact dermatitis, Acta Dermato-venereologica, 50, 287

Gonçalo M, 1998, Progrès en dermato‐allergologie, 67

10.1111/j.1365-2133.1987.tb05879.x

10.1111/j.1600-0536.1994.tb01900.x

Oliveira H S, 2000, Topical provocation in 9 cases of fixed drug eruption due to non‐steroidal anti‐inflammatory drugs, Contact Dermatitis, 42, s30

10.1111/j.1600-0536.1999.tb05989.x

10.1034/j.1600-0536.2001.440409-15.x

Robalo‐Cordeiro M, 2000, Positive lesional patch tests in fixed drug eruptions from nimesulide, Contact Dermatitis, 43, 307

10.1034/j.1600-0536.2001.440409-15.x

10.1111/j.1600-0536.1995.tb02099.x

Kaupinnen K, 1998, Skin reactions to drugs

Vaillant L, 1989, Patch testing with carbamazepine: reinduction of an exfoliative dermatitis, Arch Dermatol, 125, 299, 10.1001/archderm.1989.01670140151033

10.1111/j.1600-0536.1991.tb01657.x

Sanchez T S, 2000, Flare‐up reaction of pseudoephedrine baboon syndrome after positive patch test, Contact Dermatitis, 42, 312

Barbaud A, 1995, Place of excipients in drug related allergy, Clin Rev Allergol Immunol, 13, 253, 10.1007/BF02771765

Barbaud A, 1997, Rôle of delayed cellular hypersensitivity and adhesion molecules in maculopapular rashes induced by amoxicillin, Arch Dermatol, 133, 481, 10.1001/archderm.1997.03890400081011

10.1111/j.1600-0536.1996.tb02364.x

10.1111/j.1600-0536.1992.tb03281.x

10.1159/000249468

10.1016/S0091-6749(99)70197-1

10.1111/j.1398-9995.1995.tb05066.x

10.1111/j.1398-9995.1991.tb00560.x

10.1016/1046-199X(95)90059-4

10.1111/j.1365-2133.1996.tb01169.x

10.1111/j.1365-2133.1990.tb01457.x

10.1111/j.1600-0536.1996.tb02108.x

Figarella I, 2001, Réaction d'hypersensibilité retardée aux héparines et héparinoïdes, Ann Dermato-vénéréologica, 128, 25

10.1111/j.1600-0536.1996.tb02135.x

Silva R, 1982, Patch test diagnosis in carbamazepine erythroderma, Contact Dermatitis, 8, 283

10.1111/j.1600-0536.1985.tb01040.x

10.1111/j.1600-0536.1989.tb03152.x

10.1159/000247078

10.1111/j.1600-0536.1991.tb01814.x

10.1111/j.1600-0536.1993.tb03560.x

10.1111/j.1600-0536.1995.tb02098.x

10.1111/j.1600-0536.1996.tb02255.x

Romano A, 1992, Delayed hypersensitivity to diltiazem in two patients, Ann Allergy, 69, 31

Barbaud A, 1993, Investigations allergologiques dans une toxidermie au diltiazem (Tildiem 300 LPR), Thérapie, 48, 498

10.1016/S0140-6736(74)90417-6

10.1111/j.1600-0536.1997.tb00397.x

10.1111/j.1600-0536.1990.tb01587.x

10.1111/j.1600-0536.1992.tb00259.x

Tomb R, 1993, Allergic skin reaction to tetrazepam detected by patch testing, Eur J Dermatol, 3, 116

10.1111/j.1365-2222.1990.tb03139.x

10.1016/S0091-6749(99)70439-2

10.1111/j.1398-9995.1994.tb00809.x

Barbaud A, 1996, Allergies cutanées et insulinothérapie. Aspects récents, conduite à tenir, Ann Dermatol Venereol, 123, 214

10.1111/j.1600-0536.1994.tb02013.x

Barbaud A, 1998, Progrès en dermato‐allergologie, 75

10.1111/j.1600-0536.1993.tb03555.x

10.1034/j.1600-0536.2001.450502.x

Thông tin
Thông tin xuất bản

Contact Dermatitis

Tập 45 Số 6

321-328

Thông tin tác giả