In situ patch and repeated open application test for fixed drug eruption: a multicenter study.
drug challenge
drug patch tests
fixed drug eruption
in situ patch tests
in situ repeated open application test
Journal
The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220
Informations de publication
Date de publication:
18 Oct 2023
18 Oct 2023
Historique:
received:
21
07
2023
revised:
26
09
2023
accepted:
10
10
2023
medline:
21
10
2023
pubmed:
21
10
2023
entrez:
20
10
2023
Statut:
aheadofprint
Résumé
Few studies have evaluated allergy work-up in fixed drug eruption (FDE) in a large population. To evaluate the sensitivity of a standardized allergy workup for diagnosing the cause of fixed drug eruption, with a focus on in situ repeated open application tests (in situ ROAT). In a retrospective multicenter study, we analyzed the practice of conducting a complete allergy workup for the etiological diagnosis of FDE. It consisted of three steps: is patch tests (in situ PT) for all cases except pure mucosal involvement, followed by in situ ROAT if in situ PT results were negative, and finally a drug challenge (DC). In situ ROAT involved daily application of the suspected drug on a previously affected FDE site for 7 days. Out of 98 suspected FDE cases, 61 patients (median age 61 years, male/female ratio 1.8) with a complete allergy workup were included. In 4 cases, even the DC yielded negative results. Among the remaining 57 patients with a positive workup, implicated drugs included paracetamol (12 cases), betalactams (11 cases), imidazoles (9 cases, including 5 with metronidazole), NSAIDs (8 cases), iodinated contrast media (4 cases), cotrimoxazole (3 cases), and various other drugs in 10 patients. The diagnosis was confirmed by in situ PT in 17/54 cases (31.5%), in situ ROAT in 14/40 cases (35%) (with 4 cases showing remote reactivation of FDE sites), and DC in 26 cases. The sequential allergy workup involving successively in situ PT, in situ ROAT, and DC is a reliable and safe method for diagnosing the cause of FDE. In situ tests exhibited a sensitivity of over 50%.
Sections du résumé
BACKGROUND
BACKGROUND
Few studies have evaluated allergy work-up in fixed drug eruption (FDE) in a large population.
OBJECTIVE
OBJECTIVE
To evaluate the sensitivity of a standardized allergy workup for diagnosing the cause of fixed drug eruption, with a focus on in situ repeated open application tests (in situ ROAT).
METHODS
METHODS
In a retrospective multicenter study, we analyzed the practice of conducting a complete allergy workup for the etiological diagnosis of FDE. It consisted of three steps: is patch tests (in situ PT) for all cases except pure mucosal involvement, followed by in situ ROAT if in situ PT results were negative, and finally a drug challenge (DC). In situ ROAT involved daily application of the suspected drug on a previously affected FDE site for 7 days.
RESULTS
RESULTS
Out of 98 suspected FDE cases, 61 patients (median age 61 years, male/female ratio 1.8) with a complete allergy workup were included. In 4 cases, even the DC yielded negative results. Among the remaining 57 patients with a positive workup, implicated drugs included paracetamol (12 cases), betalactams (11 cases), imidazoles (9 cases, including 5 with metronidazole), NSAIDs (8 cases), iodinated contrast media (4 cases), cotrimoxazole (3 cases), and various other drugs in 10 patients. The diagnosis was confirmed by in situ PT in 17/54 cases (31.5%), in situ ROAT in 14/40 cases (35%) (with 4 cases showing remote reactivation of FDE sites), and DC in 26 cases.
CONCLUSION
CONCLUSIONS
The sequential allergy workup involving successively in situ PT, in situ ROAT, and DC is a reliable and safe method for diagnosing the cause of FDE. In situ tests exhibited a sensitivity of over 50%.
Identifiants
pubmed: 37863314
pii: S2213-2198(23)01139-X
doi: 10.1016/j.jaip.2023.10.021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.