Publication: Drug provocation tests in hypersensitivity drug reactions
Issued Date
2011-08-01
Resource Type
ISSN
14736322
15284050
15284050
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2-s2.0-79960847678
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Mahidol University
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SCOPUS
Bibliographic Citation
Current Opinion in Allergy and Clinical Immunology. Vol.11, No.4 (2011), 299-304
Suggested Citation
Ticha Rerkpattanapipat, Anca Mirela Chiriac, Pascal Demoly Drug provocation tests in hypersensitivity drug reactions. Current Opinion in Allergy and Clinical Immunology. Vol.11, No.4 (2011), 299-304. doi:10.1097/ACI.0b013e328348a4e9 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/12016
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Title
Drug provocation tests in hypersensitivity drug reactions
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Abstract
Purpose of review: Drug provocation test (DPT) is necessary to diagnose most drug hypersensitivity reactions (HSRs) due to decreased sensitivity of skin testing even when combined with in-vitro tests in immunonologic drug HSR and limited availability of these tests in nonimmunologic reaction. We review the principles and controversial issues of DPT, and recent studies using DPT as a diagnostic tool. Recent findings: DPT is recommended in the diagnosis of HSR to β-lactams, as well as other drug classes [such as acetylsalicylic acid-NSAIDs (ASA-NSAIDs), non-β-lactams antibiotics, heparin, glucocorticoids, and local anesthetic agents]. In view of the decreased sensitivity of skin testing, limited accessibility to new benzylpenicillin polylysine (PPL)/mixture of minor determinant (MDM) test reagents and limited availability of validated sensitive in-vitro tests, individuals who require DPT to β-lactams are increasing. The negative predictive value of allergologic work-up is very high, ranging from 94 to 98% for β-lactams and those reactions after negative tests are mostly nonimmediate and mild. Finally, DPT is recommended to ascertain tolerability of alternative compound when evaluating cross-reactivity among different classes of β-lactams, NSAIDs and glucocorticoids, and possibly iodinated contrast media. Summary: DPT is often needed when evaluating patients with suspected drug HSR. More studies regarding standardization of the various protocols are needed in order to increase its acceptance and adoption as a standard practice in the diagnostic algorithm for drug HSR. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.