Drug Provocation Tests in Hypersensitivity Drug Reactions
Drug Provocation Tests in Hypersensitivity Drug Reactions
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.
Evaluation of a drug hypersensitivity reaction (HSR) is necessary, as cutaneous eruption during pharmacotherapy may or may not be due to the drug. This procedure should be able to prove or exclude the drug as the cause of the HSR, as well as to offer well tolerated alternatives, and possibly give insight to the underlying pathomechanism. The diagnostic work-up for drug HSR involves a step-wise procedure, beginning with clinical history, then proceeding with any of skin testing, in-vitro test, or drug provocation test (DPT) depending on the type of drug and type of HSR. In this review, we summarize the general principles of DPT and some controversial issues, as well as review recent publications performing DPT as a diagnostic tool in different drug classes.
Abstract and Introduction
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.
Introduction
Evaluation of a drug hypersensitivity reaction (HSR) is necessary, as cutaneous eruption during pharmacotherapy may or may not be due to the drug. This procedure should be able to prove or exclude the drug as the cause of the HSR, as well as to offer well tolerated alternatives, and possibly give insight to the underlying pathomechanism. The diagnostic work-up for drug HSR involves a step-wise procedure, beginning with clinical history, then proceeding with any of skin testing, in-vitro test, or drug provocation test (DPT) depending on the type of drug and type of HSR. In this review, we summarize the general principles of DPT and some controversial issues, as well as review recent publications performing DPT as a diagnostic tool in different drug classes.
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