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The article focuses on the gadolinium-based contrast agents (GBCA) around the rate of hypersensitivity reaction (HS). It discusses the aim of evaluating the skin tests and intravenous provocation test (IPT), how skin prick tests (PTs) were performed and then intradermal tests were performed if negative.

In Denmark, tests for specific IgE to penicillins have been used routinely for many years in penicillin allergy investigation. Keywords: anaphylaxis; drug allergy; drug hypersensitivity; immediate type hypersensitivity; penicillin; penicillin allergy; penicillin minor determinants; specific IgE; specific IgE to penicillins EN anaphylaxis drug allergy drug hypersensitivity immediate type hypersensitivity penicillin penicillin allergy penicillin minor determinants specific IgE specific IgE to penicillins 887 890 4 08/14/23 20230801 NES 230801 Key points Specific IgE to penicillins have been recommended in the context of immediate-type allergic reactions. Our study shows that compared to the four commonly used specific IgE assays for penicillins specific IgE MD was positive in a further 29.4% of patients with suspicion of penicillin hypersensitivity, which might increase the sensitivity of penicillin sIgE testing. [Extracted from the article]

Dual intracellular staining of CD154 (CD40L) and cytokines at single-cell level: A novel aid to document immediate hypersensitivity to amoxicillin Actually, 11/15 (73%) patients demonstrated a positive CD154/IL-4 LAT (e.g. a net expression of CD154 and/or IL-4 higher than the respectively maximal values observed in tolerant controls). Keywords: amoxicillin; CD154; cytokines; flow cytometry; IFN- ; IL-4; immediate drug hypersensitivity EN amoxicillin CD154 cytokines flow cytometry IFN- IL-4 immediate drug hypersensitivity 679 682 4 06/09/23 20230601 NES 230601 Key messages Multichromatic flow cytometry enables simultaneous analysis of intracellular CD154, IL-4 and IFN- in drug-reactive T lymphocytes. In conclusion, flow-based combined analysis of intracellular expression of CD154, IL-4 and IFN- by AXE-reactive T lymphocytes is an attractive approach for safe diagnosis of immediate amoxicillin hypersensitivity reactions. [Extracted from the article]

In children with mild reactions, a simplified algorithm avoiding skin and serum testing is efficacious to manage penicillin allergy and is gaining support from the academic field. Ruling out drug allergy is always advisable as these mild clinical presentations have proven to be poor predictors of true allergy.2 Although these conditions are among the most frequent causes of allergy referral, their management is still controversial. While penicillin allergy-labels are usually acquired in childhood and up to 20% of the general population self-denominate as penicillin-allergic, only less than 6% of these are confirmed after proper work up. Allergic reactions to beta-lactam antibiotics, specifically aminopenicillin, are the most common cause of adverse drug reactions reported in children and adults.1 A substantial number of children treated with beta-lactams (BLs) develop delayed maculopapular exanthema or urticaria, and the most frequent aetiology for these symptoms is either infectious or unknown. [Extracted from the article]

Keywords: anaphylaxis; drug allergy; drug provocation test EN anaphylaxis drug allergy drug provocation test 1233 1237 5 09/04/21 20210901 NES 210901 To the editor, Drug provocation test (DPT) is considered the gold standard test to diagnose drug hypersensitivity reactions (DHR). Patients with suspicions of DHR who underwent drug allergy work-up and presented with signs/symptoms evocative of shock during the tests were included in the analysis. In conclusion, patients with sign/symptoms and signs evocative of shock are extremely rare during drug allergy work-up, therefore BP measurement could be reduced in number according to patient clinical history of DHR and drug class risk stratification. [Extracted from the article]

In the second of two linked articles, we describe the development in clinical as described by Clinical & Experimental Allergy and other journals in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered. In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered. [ABSTRACT FROM AUTHOR]

Background: Severe cutaneous adverse reactions (SCARs) are delayed‐type hypersensitivity reactions to drugs including as follows: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Stevens‐Johnson syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Acute Generalized Exanthematous Pustulosis (AGEP). Incidence, triggers and management of SCARs have not been investigated in large‐scale epidemiological studies on children. Objective: The aim of our study was to collect epidemiological, clinical and aetiological data from children with SCARs referred to our tertiary care paediatric hospital of Florence. Methods: From 2010 to 2018 charts of children with diagnosis of SCAR were reviewed, and data collected during the acute phase and/or the subsequent allergy evaluation. Patients underwent patch tests, intradermal tests and lymphocyte transformation tests. All children were investigated for infectious diseases. Results: Incidence of SCARs in hospitalized children was 0.32% over a 9‐year period. Fifty‐four children were enrolled (31 M; 23 F; median age 6.5 years): 17 cases of DRESS, 30 SJS, 3 TEN, 2 AGEP, 1 linear immunoglobulin A bullous disease (LABD) and 1 pemphigus. Twenty‐eight out of 54 patients underwent drug allergy investigations, and 50% of them resulted positive. Combining clinical history and results of allergy work‐up, 74% SCARs seem to be caused by drugs, 18.6% by both drugs and infections, 3.7% by infections, and 3.7% remained idiopathic. No deaths occurred. Conclusions: In this study, SCARs incidence is in line with literature data. Drugs were most commonly the leading cause. Management of SCARs requires cooperation among professional figures for an early diagnosis and a prompt treatment. Mortality rate seems to be lower in children. [ABSTRACT FROM AUTHOR]

The first five points in Savic et al Table 1 describe unambiguous non-allergic manifestations, patients with no personal history of penicillin allergy or patients who have tolerated penicillin after the presumed allergic reaction.[1] These patients do not warrant further allergy work-up,[[2], [4]] and the penicillin allergy label can and should be removed without further investigations. Towards a safe and efficient de-labelling penicillin allergy service by non-allergists Keywords: allergens; clinical immunology; drug allergy; epitopes; IgEimmunologic tests EN allergens clinical immunology drug allergy epitopes IgEimmunologic tests 378 379 2 03/15/23 20230301 NES 230301 To the Editor, We read with great interest the 'BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting' by Savic et al.[1] which provides guidance on evaluation and testing of patients with a possibly erroneous penicillin allergy label. [Extracted from the article]

Summary: Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe delayed hypersensitivity reaction. The determination of drug causality is complex. The lymphocyte transformation test (LTT) has been reported positive in more than 50% of DRESS cases. Nevertheless, the sensitivity and specificity of LTT specifically in DRESS have not yet been established. Rechallenge with the culprit drug is contraindicated and cannot be used as gold standard for sensitivity and specificity determination. Objective: To estimate the sensitivity and specificity of LTT in a clinically defined series of patients with DRESS. Methods: Some 41 patients diagnosed with DRESS were included in the study. The results of the algorithm of the Spanish Pharmacovigilance System were used as the standard for a correct diagnosis of drug causality. A standard LTT was performed with involved drugs in acute or recovery samples. A stimulation index (SI) ≥2 in at least one concentration except for beta‐lactams (SI ≥3) and contrast media (SI ≥4) was considered positive. Contingency tables and ROC curves were used for analysis. Results: Sensitivity and specificity of LTT in the recovery phase of DRESS were 73% and 82%, respectively, whereas in the acute phase, they were only 40% and 30%, respectively. Comparison of skin tests and LTT confirmed a higher sensitivity and specificity of LTT in DRESS. LTT showed high sensitivity (S) and specificity (Sp) for anticonvulsants (S 100%, Sp 100%; P = .008), anti‐TB drugs (S 87.5%, Sp 100%; P = .004), and beta‐lactams (S 73%, Sp 100%; P = .001). ROC curves revealed that the best criteria for LTT positivity for all drugs are SI ≥2 in at least one concentration, increasing overall sensitivity to 80%, and for beta‐lactams from 73% to 92%. Conclusions and clinical relevance: LTT is a good diagnostic tool for drug causality in DRESS, mainly when performed in the recovery phase. [ABSTRACT FROM AUTHOR]

Background The diagnosis of HSR to iodinated contrast media ( ICM) is challenging based on clinical history and skin tests. Objective This study evaluates the negative predictive value ( NPV) of skin tests and intravenous provocation test ( IPT) with low-dose ICM in patients with suspected immediate hypersensitivity reaction ( HSR) to ICM. Methods Thirty-seven patients with suspected immediate hypersensitivity reaction to ICM were included retrospectively. Skin tests and a single-blind placebo-controlled intravenous provocation test ( IPT) with low-dose iodinated contrast media ( ICM) were performed. Results Skin tests with ICM were positive in five cases (one skin prick test and five intradermal test). Thirty-six patients were challenged successfully by IPT, and only one patient had a positive challenge result, with a grade I reaction by the Ring and Messmer classification. Ten of 23 patients followed up by telephone were re-exposed to a negative tested ICM during radiologic examination; two experienced a grade I immediate reaction. Conclusions & Clinical Relevance For immediate hypersensitivity reaction to ICM, the NPV for skin tests and IPT with low dose was 80% (95% CI 44-97%). [ABSTRACT FROM AUTHOR]

The Standards of Care Committee of the British Society for Allergy and Clinical Immunology ( BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included. [ABSTRACT FROM AUTHOR]

As in previous years, we felt it would be of value to our readership to summarize the new information provided by the authors who have published in Clinical and Experimental Allergy in 2011 and set this in the context of recent advances in our understanding of the pathogenesis and management of allergic disease in all its many manifestations. In 2011, about 210 articles were published in Clinical and Experimental Allergy including editorials, reviews, opinion articles, guidelines, letters, book reviews and of course at the heart of the journal, papers containing original data. As before, this review is divided into sections based on the way the journal is structured, although this year we have grouped together all the papers dealing with mechanisms of allergic disease, whether they involve patients (clinical mechanisms), pure in vitro studies (basic mechanisms) or animal models (experimental models), as we felt this was a more coherent way to deal with the subject. In the field of asthma and rhinitis, the relationship between airway inflammation and airway dysfunction was of perennial interest to investigators, as were phenotypes and biomarkers. Aspirin hypersensitivity appeared in studies in several papers and there was new interest in asthma in the elderly. The mechanisms involved in allergic disease describe advances in our understanding of T cell responses, the relationship between inflammation and disease, mast cell and basophil activation, steroid resistance and novel therapies. In the section dealing with epidemiology, studies seeking to identify risk factors for allergic disease including vitamin D are prominent, as once again are studies investigating gene-environment interactions. The clinical allergy section focuses on drug allergy, food allergy and immunotherapy. The area of oral immunotherapy for food allergy is well covered and we were grateful to Stephen Durham for guest editing an outstanding special issue on immunotherapy in the centenary year of Leonard Noon's pioneering work. Lastly, in the field of allergens, the interest in component-resolved diagnosis continues to grow and there are also articles describing important novel cultivars and the effect of food processing on the allergenic properties of foods. Another terrific year, full of important and high-quality work,which the journal has been proud to bring to the allergy community. [ABSTRACT FROM AUTHOR]

Summary Background Prior use of 'lymphocyte transformation test' ( LTT) in Stevens- Johnson syndrome ( SJS) and toxic epidermal necrolysis ( TEN) provided conflicting results, possibly dependent on sampling dates (acute vs. late). Objective Evaluation of LTT in patients with SJS or TEN who reacted to lamotrigine ( LTG). In a small subgroup we explored the possible role of regulatory T cells (T-reg). Methods Acute phase samples (9) and post-recovery samples (14) from cases of SJS or TEN to LTG were provided by the Regi SCAR-study group. Controls were persons never exposed to LTG (12), patients exposed without reaction (6), and patients who developed a mild eruption to LTG (6). LTT was performed by measuring 3H-thymidine incorporation after 3 days of incubation with phytohemmaglutinin, LTG (10 μg/mL) or medium. Stimulation index ≥ 2 was considered positive. In 16 cases LTT was redone after depletion of T-reg by fluorescence activated cell sorting. Results Positive LTT was observed in 3/6 cases of mild eruptions, 1/9 SJS/ TEN-cases tested during the acute phase and 3/14 SJS/ TEN-cases tested after recovery. We noted a very mild and nonsignificant trend for an increased response after depletion of T-reg in late samples from SJS or TEN patients. Conclusions and Clinical Relevance With the largest number of LTT performed in patients with SJS or TEN to a single drug, we confirmed that reactive cells are rarely detected in these reactions. Poor reactivity did not seem related to T-reg. Other in vitro assays than those testing proliferation should be evaluated, before raising the hypothesis that specific cells disappeared by undergoing apoptosis during the reaction. [ABSTRACT FROM AUTHOR]

These guidelines have been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and are intended for allergists and others with a special interest in allergy. As routine or validated tests are not available for the majority of drugs, considerable experience is required for the investigation of allergic drug reactions and to undertake specific drug challenge. A missed or incorrect diagnosis of drug allergy can have serious consequences. Therefore, investigation and management of drug allergy is best carried out in specialist centres with large patient numbers and adequate competence and resources to manage complex cases. The recommendations are evidence-based but where evidence was lacking consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, clinical patterns of drug allergy, diagnosis and treatment procedures. In order to achieve a correct diagnosis we have placed particular emphasis on obtaining an accurate clinical history and on the physical examination, as these are critical to the choice of skin tests and subsequent drug provocation. After the diagnosis of drug allergy has been established, communication of results and patient education are vital components of overall patient management. [ABSTRACT FROM AUTHOR]

Background β-Lactam (BL) antibiotics can induce non-immediate skin reactions, frequently manifested as exanthema or urticaria. The time between drug intake and the reaction appearance is generally 24–48 h. Because the mechanisms involved are not completely understood, diagnostic tests for these reactions have still to be fully validated. Objective To evaluate the role of skin and drug provocation tests (DPTs) in the diagnosis of patients with non-immediate reactions to BL. Methods We evaluated a group of 22 patients who developed maculopapular exanthema or urticarial exanthema after BL intake. Diagnosis was confirmed by DPT with BL. Intradermal/patch testing was performed with benzylpenicilloyl, minor determinant mixture, amoxicillin (AX), ampicillin (AMP) and the culprit drug in patients and in 22 negative controls. Immunohistochemical studies were done in the affected skin at the acute phase of the reaction and after a delayed positive skin test/DPT. IFN-γ and IL-4 were quantified in peripheral mononuclear cells, obtained during the positive response to DPT and after resolution of the symptoms. Results From the total number of cases, 12 patients developed urticarial exanthema and 10 maculopapular exanthema after DPT. Only two of the 22 patients (9%) had a positive delayed intradermal skin test: one to AX/AMP and the other to cloxacillin. Biopsies showed a mononuclear CD4, CD8 infiltrate and activated and memory cells. The cytokine expression showed a Th1 pattern in patients, in contrast with the Th0 pattern in controls. Conclusion In patients with non-immediate reactions to BLs (maculopapular exathema or urticarial exanthema), the sensitivity of skin testing is low and DPT may be required to establish the diagnosis. The reproducibility of the reactions and the cytokine pattern expressed during the acute episode support a T cell-induced non-immediate response. [ABSTRACT FROM AUTHOR]

Background In our clinic we routinely patch test patients referred from occupational health for the investigation of latex contact urticaria. We also undertake both patch and prick testing (where indicated) in patients referred with persistent dermatitis/eczema. If investigation of allergic skin disease is undertaken by a non-dermatologist, it is unlikely that patch testing will be performed. Objective To carry out a retrospective analysis of patients who had been prick tested to establish whether an incomplete diagnosis would have been reached if patch testing had been omitted. Methods Details of patients who had attended for patch testing between July 2004 and December 2005 were analysed. Patients who had had prick tests and patch testing were identified. The outcomes of prick tests and patch testing were documented together with the clinical relevance. Results Three hundred and thirty out of 1060 patients referred to the clinic were prick tested. 54.2% patients were referred from dermatologists. 26.6% were referred from occupational health, 68 patients had positive reactions on prick testing of whom 36 had positive patch tests (52.9%), which were of current relevance in 27 patients (39.7%). Nine out of 106 health workers referred to exclude latex contact urticaria had positive prick tests to latex. Fifty of these patients demonstrated delayed-type hypersensitivity with nickel, cobalt, rubber and its additives being the most common allergens found. Of the 262 patients who had negative prick tests, 121 had positive patch tests (46.1%) of current relevance to patient history in 92 subjects (35.1%). While none of the six patients referred for investigation of reaction to local anaesthetics had a positive prick test, one was allergic to local anaesthetic on patch testing. Conclusion Omission of patch testing from the investigation of allergic skin disease, even when contact urticaria may be the sole suspected diagnosis, would result in the frequent missed diagnosis of contact allergy. We recommend that patients with suspected allergic skin disease are investigated in an environment where investigation of both immediate- and delayed-type hypersensitivity can be undertaken. In particular, patients with atopic eczema, suspected latex rubber allergy, hand dermatitis (particularly occupational) and drug reactions should be targeted to receive both investigations. [ABSTRACT FROM AUTHOR]

Background Skin prick and intradermal skin tests (IDT) are useful tools in evaluating IgE-mediated allergic disorders. In the literature, many variations of the techniques used are described. No general agreement exists on test procedures and reading of test results. Objective To analyse test conditions for IDT to facilitate comparability between different study protocols. Methods We tested 24 healthy volunteers with three concentrations of histamine and codeine each on the upper back, lateral upper arm and volar forearm, with/without addition of ethylene diamine tetra-acetic acid. Reading of the resulting weal was performed by taking a digital image of the weal, later outlining the weal perimeter in triplicate and calculating the weal area using the NIH Image J software version 1.3. Results Weal size was dose dependent for both substances, generally larger on the upper back than on the forearm and upper arm, and larger after codeine than after histamine. Addition of the Ca2+-chelator ethylene diamine tetra-acetic acid did not significantly affect weal size. Weal size induced by histamine showed better consistency than that induced by codeine. Conclusions The results and our technique provide valuable tools for the daily routine as well as for the ability to compare information of intradermal tests from different studies or clinical reports. When assessing skin reactivity, we recommend the use of 1 mg/mL codeine as well as 0.1 mg/mL histamine to reflect aspects of mast-cell releasability and of vascular reactivity. The involvement of local factors influencing the vascular reactivity or differences in opiate receptor density on mast cells surfaces needs to be addressed in future studies. [ABSTRACT FROM AUTHOR]

Background Iodinated contrast media (ICM) hypersensitivity reactions represent a serious problem. Very few clinical data concerning systematic skin testing to ICM are available. Objective To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity. Material and methods All patients referred over a 6-year period for ICM hypersensitivity past reactions were skin tested for (a) the implicated ICM, or (b) a set of ICM if they were positive for the implicated ICM or if its name was unknown. Results Forty-four patients, with a median age of 56 years, were studied (15 males, 29 females). The ICM skin tests were positive in 10 patients (23%): one had a positive skin prick test, seven an immediate positive intradermal test (IDT) and two a delayed positive IDT. Skin tests were more often positive in patients with immediate (9/32) as compared with those with non-immediate reactions (1/11). The time interval between the reaction and skin testing was shorter for those patients with an immediate ICM reaction and a positive skin test result (3 months [2.5–174.0]) as compared with those with an immediate ICM reaction and a negative skin test (48 months [6.8–159.0]), ( P<0.05). Respiratory allergy was more frequent in the positive group (6/10 vs. 7/34, P<0.05). Conclusions Skin tests with ICM are positive in a subgroup of patients with ICM hypersensitivity and may play an important role in the diagnosis of ICM allergy. [ABSTRACT FROM AUTHOR]

Background After penicillins, cephalosporins are the betalactams that most often induce IgE-mediated reactions. The development of diagnostic tests has been delayed, however, because the cephalosporin allergenic determinants have not been properly identified. Objective To evaluate the usefulness of skin tests, serum specific IgE assays, and challenges in diagnosing immediate reactions to cephalosporins and to clarify the pathogenic mechanism of such reactions. Methods We studied 76 adults with immediate reactions to cephalosporins, mainly ceftriaxone, cefotaxime, and ceftazidime. Skin tests and serum specific IgE assays were performed for culprit cephalosporins and cefaclor, as well as for penicillin, amoxicillin, and ampicillin. Some subjects with negative results underwent challenges and re-evaluations. Responses to cephalosporins other than the culprit ones were also studied. Results In the first allergologic work-up, an IgE-mediated hypersensitivity to penicillins and/or cephalosporins was diagnosed in 63 (82.9%) of the 76 patients on the basis of skin-test and/or specific IgE assay positivity. Of the 13 negative patients, eight accepted challenges and underwent re-evaluations. Considering both first- and second-evaluation results, the skin-test-positivity rate increased from 76.3% to 85.5% and that of sepharose-radioimmunoassay positivity from 67.1% to 74.3%. Overall, an IgE-mediated hypersensitivity was diagnosed in 70 patients (in seven after retesting). On the basis of skin-test and CAP-FEIA results, we classified our 76 patients into five groups: group A (three patients), positive only to penicillin reagents; B (17), positive to both cephalosporin and penicillin reagents; C (24), positive to more than one cephalosporin; D (21), positive only to the responsible cephalosporin; E (11) negative to skin tests and CAP-FEIA, including five sepharose-radioimmunoassay positive. Conclusions Most immediate reactions to cephalosporins appear to be IgE-mediated. Cephalosporin skin testing and sepharose-radioimmunoassay are useful tools for evaluating these reactions. Cephalosporin IgE-mediated hypersensitivity may be a transient condition; therefore, allergologic exams should be repeated in patients with negative initial allergologic work-ups, including challenges. [ABSTRACT FROM AUTHOR]

Summary Up to 3% of all hospital admissions are due to adverse drug reactions (ADRs), and between 10% and 20% of hospital inpatients develop ADRs. Individual susceptibility to becoming ‘sensitized’ or allergic to a drug is thought to result from altered metabolic handling of the drug. Reactive intermediate compounds form haptens, bind to proteins and induce immune responses. Depending on whether the immune system generates antibodies or sensitized T cells, different clinical patterns of hypersensitivity may result. At present, both in vivo or in vitro tests to identify the culprit drug or to confirm the presence of hypersensitivity are not widely used because they are either not generally robust or not readily accessible. In vitro tests require the true immunogen/antigen to detect antibodies or sensitized T cells. As the metabolic basis underlying susceptibility to adverse drug reactions is elucidated, the resolution of immunological mechanisms and development of reliable tests will ensue. This will also become of great value for prediction of individuals at risk of becoming sensitized by a particular drug. [ABSTRACT FROM AUTHOR]

Background Cutaneous amoxicillin- and penicillin-mediated reactions can be classified as immediate and delayed-type reactions. Immediate reactions are thought to involve IgE antibodies and have been studied extensively. In contrast only few data exist about delayed reactions such as morbilliform or maculopapular rash. Objective To assess the predictive value of immediate skin tests, skin-patch tests, specific IgE and lymphocyte transformation tests with regard to the diagnosis of delayed skin eruptions. Methods Skin and in vitro tests were performed in 18 subjects. Twelve subjects had penicillin- or amoxicillin-induced morbilliform exanthema and six were controls without hypersensitivity reaction, tested before and after exposure. Results Specific IgE to penicillin and immediate penicillin skin tests were negative in amoxicillin- or penicillin-induced delayed skin eruptions. In contrast, skin-patch testing and LTT were positive in 9/12 or 10/12, respectively, but negative in all six controls. Conclusion These findings substantiate a T-cell-mediated immune pathomechanism in the majority of penicillin-induced delayed skin reaction. Moreover, they underline the necessity to adapt the test procedures to underlying pathomechanisms and support the diagnostic value of skin-patch testing and LTT in delayed cutaneous reactions to penicillins. [ABSTRACT FROM AUTHOR]

Before attempting rechallenge, benefit-risk of a medication must be favourable compared to that of best available alternative treatments.[3] Hence, in order to permit wider use of the procedure, it would be valuable to understand the criteria used to classify a medication as "essential". Hence, daclizumab-specific DRESS syndrome meets the diagnostic criteria, but has obviously a distinct clinical picture and pathogenesis. [Extracted from the article]

Cite this as: S. Nasser, Clinical & Experimental Allergy, 2010 (40) 697–699. [ABSTRACT FROM AUTHOR]