Towards standardized skin testing for drug-induced allergic reactions

Standardization of skin tests is essential for detecting allergen sensitization, confirming diagnoses, and guiding treatment of allergen-induced conditions. The rise in drug-induced reactions presents a challenge to healthcare practitioners, as incomplete or inaccurate drug allergy histories can compromise patient safety and result in medication errors. Drug hypersensitivity reactions (DHR) are akin to allergic responses, triggered by either the active ingredient or excipients in a drug. Distinguishing between a drug allergic reaction and a predictable adverse drug reaction (ADR) is vital in clinical practice. Cutaneous testing, a common diagnostic modality, uses non-irritant drug concentrations, tested and validated for key drug classes. This article collects up-to-date concentrations, serving as a reference for healthcare practitioners. These concentrations vary but are generally prepared by dissolving the commercial form of the drug's tablet or capsule content in normal saline, white petrolatum, or sterile water for irrigation. However, the lack of data and standardized protocols on optimal non-irritant drug concentrations for oral dosage forms has led to variability in these tests' sensitivity, specificity, and performance.