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Patch testing in non-immediate hypersensitivity to cotrimoxazole: Is it useful?

João Nuno Soares1,2, João Pedro Teixeira1, Ana Carolina Figueiredo1

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Patch testing (PT) with cotrimoxazole (CTX) shows low sensitivity for diagnosing non-immediate cutaneous adverse drug reactions (CADR). Clinicians should exercise caution when interpreting negative CTX patch test results in suspected cases.

Keywords:
DRESSadverse drug reactionsantibioticcotrimoxazolecutaneousnon‐immediatepatch testing

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Area of Science:

  • Dermatology
  • Pharmacology
  • Allergy and Immunology

Background:

  • Existing literature raises concerns about the diagnostic sensitivity of patch testing (PT) for cotrimoxazole (CTX)-induced hypersensitivity.
  • Non-immediate cutaneous adverse drug reactions (CADR) are a significant clinical concern, necessitating reliable diagnostic tools.

Purpose of the Study:

  • To evaluate the sensitivity of patch testing (PT) using cotrimoxazole (CTX) in patients experiencing non-immediate cutaneous adverse drug reactions (CADR).
  • To assess the utility of different CTX preparations in patch testing for diagnosing drug hypersensitivity.

Main Methods:

  • A retrospective analysis of 64 patients with suspected non-immediate CADR to CTX between 2000 and 2022.
  • Patch testing was performed using commercial CTX (10% pet) and in-house preparations of CTX and trimethoprim, following ESCD guidelines.

Main Results:

  • No positive reactions were observed with commercial or in-house CTX preparations in patch testing.
  • One patient showed a positive reaction exclusively to trimethoprim.
  • Two patients exhibited faint, transient reactions to CTX powder, deemed irritant and non-specific.

Conclusions:

  • Patch testing appears to have insufficient sensitivity for diagnosing CTX-induced non-immediate CADR.
  • Clinical interpretation of negative CTX patch test results requires careful consideration due to potential false negatives.