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Skin Testing Approaches for Immediate and Delayed Hypersensitivity Reactions.

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  • 1département de Dermatologie et Allergologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Paris F75020, France.

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Summary

Patch tests (PTs), skin prick tests (SPTs), and intradermal tests (IDTs) help identify drugs causing adverse drug reactions (ADRs) and find safer alternatives. Diagnostic accuracy varies by ADR type and drug.

Keywords:
Delayed hypersensitivityDiagnosisDrugsImmediate hypersensitivityIntradermal testsPatch testsPrick testsProvocation tests

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Area of Science:

  • Clinical immunology
  • Dermatology
  • Pharmacology

Background:

  • Adverse drug reactions (ADRs) pose significant clinical challenges.
  • Accurate diagnosis is crucial for patient safety and effective treatment.
  • Identifying causative agents and safe alternatives requires reliable diagnostic methods.

Purpose of the Study:

  • To evaluate the diagnostic utility of patch tests (PTs), skin prick tests (SPTs), and intradermal tests (IDTs) in adverse drug reactions.
  • To determine the sensitivity of these tests for specific ADR classifications and drug types.

Main Methods:

  • Review of diagnostic procedures including PTs, SPTs, and IDTs for ADR evaluation.
  • Analysis of test performance based on clinical features of ADRs.
  • Correlation of test results with specific drug classes and hypersensitivity reactions.

Main Results:

  • PTs demonstrate good sensitivity for acute generalized exanthematous pustulosis and drug rash with eosinophilia and systemic symptoms.
  • SPTs are valuable for immediate hypersensitivity reactions to most drugs, excluding opiates.
  • IDTs show sensitivity for immediate hypersensitivity to beta-lactam antibiotics, iodinated contrast media, heparins, general anesthetics, and platinum salts.

Conclusions:

  • The diagnostic value of PTs, SPTs, and IDTs in ADRs is contingent upon the specific clinical presentation and the drug involved.
  • These in vivo tests are essential tools for identifying culprit medications and guiding the selection of safe alternative therapies.
  • Tailoring the choice of diagnostic test to the suspected ADR type and drug class optimizes diagnostic yield.