Skin tests in the work‐up of cutaneous adverse drug reactions: A review and update

Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions (CADRs), and determining safer, alternative drugs. PTs have a low sensitivity but are valuable in investigating maculopapular exanthema (MPE)...

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Bibliographic Details
Published in:Contact dermatitis Vol. 86; no. 5; pp. 344 - 356
Main Authors: Barbaud, Annick, Castagna, Julie, Soria, Angèle
Format: Journal Article
Language:English
Published: Oxford, UK Blackwell Publishing Ltd 01.05.2022
Wiley Subscription Services, Inc
Subjects:
Acute Generalized Exanthematous Pustulosis - diagnosis
Acute Generalized Exanthematous Pustulosis - etiology
cutaneous adverse drug reactions
delayed‐type drug hypersensitivity
Dermatitis, Allergic Contact
diagnosis
Drug Hypersensitivity Syndrome - diagnosis
Drug Hypersensitivity Syndrome - etiology
drug skin tests
Eosinophilia
Exanthema
Humans
Hypersensitivity (delayed)
Hypersensitivity (immediate)
immediate‐type drug hypersensitivity
intradermal tests
Opioids
Patch Tests
prick tests
Pustulosis
review
Skin Tests
Stevens-Johnson Syndrome - diagnosis
Stevens-Johnson Syndrome - etiology
Toxic epidermal necrolysis
prick tests
immediate-type drug hypersensitivity
intradermal tests
review
drug skin tests
patch tests
delayed-type drug hypersensitivity
diagnosis
cutaneous adverse drug reactions
ISSN:0105-1873, 1600-0536, 1600-0536
Online Access:Get full text
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Summary:Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions (CADRs), and determining safer, alternative drugs. PTs have a low sensitivity but are valuable in investigating maculopapular exanthema (MPE), as well as severe CADR, including toxic epidermal necrolysis (TEN), Stevens‐Johnson syndrome (SJS), and in particular, acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). To ensure their specificity, at least 10 control tests should be performed. Prick tests are mainly used in the evaluation of immediate‐type hypersensitivity and can be performed with all drugs, except opiates. IDTs can be used to explore immediate and delayed‐type hypersensitivity, if an injectable form of the drug exists. Except for SJS/TEN, IDTs should be performed by injecting 0.02 mL of the drug. We here provide a practical, up‐to‐date review on the use of these skin tests in the work‐up of CADRs. Numerous negative controls for drug PTs, as well as criteria for the immediate and delayed positivity of prick tests and IDT, are included. It should be emphasized that a negative result never excludes the potential responsibility of a drug in a CADR.
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ISSN:0105-1873
1600-0536
1600-0536
DOI:10.1111/cod.14063