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Updated: Jul 12, 2025

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In Situ Patch Test and Repeated Open Application Test for Fixed Drug Eruption: A Multicenter Study.

Hélène Traineau1, Brigitte Milpied2, Angèle Soria3

  • 1Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.

The Journal of Allergy and Clinical Immunology. in Practice
|October 20, 2023
PubMed
Summary
This summary is machine-generated.

A standardized allergy workup, including in situ patch tests (PTs) and repeated open application tests (ROATs), reliably diagnoses fixed drug eruption (FDE). This sequential approach, including drug challenges (DCs), proves safe and effective for identifying FDE causes.

Keywords:
Drug challengeDrug patch testsFixed drug eruptionIn situ patch testsIn situ repeated open application test

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Area of Science:

  • Dermatology
  • Allergology
  • Clinical Immunology

Background:

  • Fixed drug eruption (FDE) diagnosis lacks extensive population-based allergy workup studies.
  • Identifying causative agents is crucial for patient management and preventing recurrence.

Purpose of the Study:

  • To assess the diagnostic sensitivity of a structured allergy workup for fixed drug eruption.
  • To evaluate the efficacy of in situ repeated open application tests (ROATs) within this workup.

Main Methods:

  • A retrospective multicenter study analyzed a 3-step allergy workup for FDE: in situ patch tests (PTs), in situ ROATs, and drug challenges (DCs).
  • In situ ROAT involved daily application of suspected drugs to affected sites for 7 days.

Main Results:

  • Of 61 patients with complete workup, 57 had a positive diagnosis. Common culprits included paracetamol, beta-lactams, and NSAIDs.
  • Diagnosis confirmation rates: in situ PT (31.5%), in situ ROAT (35%), and DC (26%).
  • In situ tests demonstrated over 50% sensitivity in diagnosing FDE.

Conclusions:

  • A sequential allergy workup incorporating in situ PTs, in situ ROATs, and DCs is a dependable and safe method for diagnosing FDE.
  • In situ diagnostic methods show promising sensitivity for identifying drug triggers in fixed drug eruption.