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Clindamycin skin testing has limited diagnostic potential
Melissa J Notman1, Elizabeth J Phillips, Sandra R Knowles
1Drug Safety Clinic, Division of Clinical Pharmacology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Abstract:
We examined the role of clindamycin prick and intradermal skin testing in a tertiary care clinic population. Experience with diagnostic modalities such as prick and intradermal testing has been limited with clindamycin. A retrospective chart review was conducted for patients with immunologic reactions temporally associated with clindamycin who were referred to the Drug Safety Clinic (Toronto, Ontario). A total of 31 patients were identified who had undergone prick and intradermal skin testing. All 31 negative immediate prick and intradermal tests were followed by a 150 mg oral dose of clindamycin. 10/31 (32%) subjects had significant reactions to the oral clindamycin provocation. 2 patients reported delayed reactions at the clindamycin intradermal test sites. Our experience suggests that prick and intradermal skin testing is not adequate in identifying patients with previous allergic reactions associated with clindamycin. Oral provocation tests can be used in patients with histories of clindamycin adverse reactions; however, it should be offered on a risk-benefit basis.
Insights
Clindamycin skin testing is not reliable for diagnosing allergies. Oral provocation tests may identify clindamycin hypersensitivity but carry risks, requiring careful consideration of benefits versus potential adverse reactions.
Area of Science:
- Clinical Immunology
- Pharmacology
- Dermatology
Background:
- Limited data exists on the efficacy of clindamycin prick and intradermal skin testing for diagnosing allergic reactions.
- Immunologic reactions to clindamycin necessitate reliable diagnostic methods for patient safety.
Purpose of the Study:
- To evaluate the diagnostic accuracy of clindamycin prick and intradermal skin testing in patients with suspected hypersensitivity.
- To assess the safety and utility of oral clindamycin provocation following negative skin tests.
Main Methods:
- Retrospective chart review of 31 patients referred to a Drug Safety Clinic for clindamycin-associated immunologic reactions.
- Patients underwent clindamycin prick and intradermal skin testing.
- Negative skin tests were followed by a 150 mg oral clindamycin challenge.
Main Results:
- Prick and intradermal skin testing showed limited sensitivity in identifying patients with previous clindamycin allergic reactions.
- 32% (10/31) of patients experienced significant reactions upon oral clindamycin provocation.
- Two patients reported delayed reactions at intradermal test sites.
Conclusions:
- Clindamycin prick and intradermal skin testing are inadequate for ruling out previous allergic reactions.
- Oral clindamycin provocation can be a useful tool for diagnosing hypersensitivity but must be administered cautiously on a risk-benefit basis.
