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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Vydáno v:	Contact dermatitis Ročník 86; číslo 5; s. 344 - 356
Hlavní autoři:	Barbaud, Annick, Castagna, Julie, Soria, Angèle
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Oxford, UK Blackwell Publishing Ltd 01.05.2022 Wiley Subscription Services, Inc
Témata:	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
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Abstract	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.
AbstractList	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. 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.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.
Author	Castagna, Julie Soria, Angèle Barbaud, Annick
Author_xml	– sequence: 1 givenname: Annick orcidid: 0000-0001-8889-1589 surname: Barbaud fullname: Barbaud, Annick email: annick.barbaud@aphp.fr organization: Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie – sequence: 2 givenname: Julie orcidid: 0000-0002-9983-9521 surname: Castagna fullname: Castagna, Julie organization: Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie – sequence: 3 givenname: Angèle orcidid: 0000-0002-8726-6658 surname: Soria fullname: Soria, Angèle organization: INSERM 1135 Cimi‐Paris, Hôpital Tenon, Assistance Publique‐Hôpitaux de Paris, Département de dermatologie et d'allergologie
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Snippet	Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions...
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SubjectTerms	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
Title	Skin tests in the work‐up of cutaneous adverse drug reactions: A review and update
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