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Skin testing with a suspected drug has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADR). Many isolated reports of positive drug skin tests are published, but without detailed information concerning the clinical features of the CADR and the method used in performing drug skin tests, such data are not very informative. A working party of the European Society of Contact Dermatitis (ESCD) for the study of skin testing in investigating cutaneous adverse drug reactions, has proposed the herein-reported guidelines for performing skin testing in CADR in order to standardize these procedures. In each reported case, the imputability of each drug taken at the onset of the CADR and a highly detailed description and characterization of the dermatitis need to be given. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed according to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested diluted at 30% pet. (pet.) and/or water (aq.). The pure drug is tested diluted at 10% in pet. or aq. In severe CADR, drug patch tests are performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR. Drug prick tests are performed on the volar forearm skin with the commercialized form of the drug, but with sequential dilutions in cases of urticaria. Intradermal tests (IDT) are performed with sterile sequential dilutions (10–4, 10–3, 10–2, 10–1) of a pure sterile or an injectable form of the suspected drug with a small volume of 0.04 ml. Drug skin tests need to be read at 20 min and also later at D2 and D4 for patch tests, at D1 for prick tests and IDT. All these tests also need to be read at 1 week. The success of skin tests varies with the drug tested, with a high % of positive results, for example, with betalactam antibiotics,... [ABSTRACT FROM AUTHOR]

Background. Drug patch tests (DPTs) with medicaments suspected of causing an allergic reaction represent a method of diagnostic testing that is low risk; DPTs can reproduce delayed hypersensitivity to drugs, and entail only a moderate re-exposure of patients to potential offending drugs. We assessed the non-irritating concentrations of DPTs and determined the amounts of active ingredient (AI) contained in the drugs used in the tests. Objectives. The objectives were to assess the non-irritating concentration of DPTs and determine the amounts of active ingredient (AI) contained in the drugs used in the tests. Methods. From a retrospective, single-centre study of all patients investigated during a 6-year period with a drug eruption, each potentially responsible drug was tested with the commercially available preparation diluted to 30% in water, petrolatum, or alcohol. Data collection was performed with a customized computer database. For each type of DPT studied, the numbers of positive and negative test results were recorded. The amount of AI contained in the DPT (as a percentage) was then calculated after weighing of each tablet. Results. Of the 5558 DPTs studied, all were non-irritant. The average concentration of AI was 9.8%; 25% of DPTs had an AI concentration of <2%, and 25% had an AI concentration of >16%. The AI concentration ranged from 0.05% (digoxin) to 30% (paracetamol lyophilisate). Conclusion. These data provide thresholds for the non-irritating concentration of AI of 68 different drugs, and thresholds for the non-irritating dilution for 82 drugs, and will help to standardize DPT methods. [ABSTRACT FROM AUTHOR]

Keywords: acyclovir; adverse drug reaction; allergic contact dermatitis; antiviral drugs; case report; drug allergy EN acyclovir adverse drug reaction allergic contact dermatitis antiviral drugs case report drug allergy 203 205 3 02/25/21 20210301 NES 210301 CASE REPORT A 27-year-old woman was referred to our department because of a 1-year history of recurrent episodes of edema and eczema of the face. 7 Vernassiere C, Barbaud A, Trechot PH, Weber-Muller F, Schmutz JL. Systemic acyclovir reaction subsequent to acyclovir contact allergy: which systemic antiviral drug should then be used? Acyclovir, adverse drug reaction, allergic contact dermatitis, antiviral drugs, case report, drug allergy. [Extracted from the article]

The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. One hundred and five drugs were identified that have together caused 536 positive patch tests in 437 DRESS patients. By far, the most reactions (n = 145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions were anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%), and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin), and, possibly, iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing. [ABSTRACT FROM AUTHOR]

Background: Patch tests (PTs) with two readings have been used for decades to identify the culprit drug in nonimmediate cutaneous adverse drug reactions (NICADRs), followed more recently by late reading of intradermal tests (IDTs). Some teams tend to perform PTs with only one reading before IDTs or even directly perform IDTs. Objectives: To evaluate the relevance of a late PT reading on day 4 (D4) in NICADRs. Methods: We retrospectively selected patients who had a PT for an NICADR between July 2014 and March 2020. Results: During the study period, 328 patients had a PT with available results. Among the 75 positive‐PT patients with available data for the two readings, 41 (54.7%) had positive results on D2 and D4 and 34 (45.3%) had negative results on D2 but positive results on D4. No patient had positive results on D2 and negative results on D4. Conclusion: This study shows that a D4 reading enhanced the PT‐positive results. A positive PT result allows for reducing the number of IDTs, which are more difficult and costly to perform. Our series suggests that a late PT reading at D4 should be performed for exploring NICADRs. [ABSTRACT FROM AUTHOR]

Background: Cutaneous drug eruptions are common side-effects. The imputation score combining intrinsic (chronology, clinical and paraclinical signs) and extrinsic criteria used in Pharmacovigilance Centres is insufficient alone to identify with certainty a responsible drug. Objective: To evaluate the imputation score before and after performing skin testing in patients with cutaneous drug eruptions. Patients/Methods: A single-centre retrospective study was performed on 339 patients tested between 2001–2006. Imputation scores were calculated before and after skin tests for each cutaneous drug eruption according to the clinical type of skin eruption and the type of drug. Results: Among 121 patients meeting inclusion criteria, 46% showed an increase of the imputation score as shown by 25/41 cases of maculo-papular exanthema, 4/11 cases of acute generalized exanthematous pustulosis and 17/41 cases of urticaria/anaphylaxis. The imputation score increased in 25/70 cases of the tested antibiotic drugs, in 14/56 cases of cardiovascular drugs, and it increased in 19 patients (34%) with I1 or I2 imputation scores before skin testing and in 29 (52%) with an I3 imputation score before skin testing. Conclusions: Drug skin testing appeared useful in investigating cutaneous drug eruptions in routine practice, including not only drugs with a high imputation score (I3) but also those with a lower score (I1, I2). Drug skin testing should lead to oral rechallenge of drugs with negative tests in order to determine which drugs may be used safely. [ABSTRACT FROM AUTHOR]

We report two patients with contact allergy to diclofenac and subsequent tolerance in oral challenge tests. Allergic contact dermatitis (ACD) after topically applied diclofenac1,2 and type IV reactions after oral intake are rarely reported.3 To date, no study exists on possible oral tolerance in patients with contact allergy to topical diclofenac. Keywords: allergic contact dermatitis; case report; diclofenac; systemic tolerance EN allergic contact dermatitis case report diclofenac systemic tolerance 41 43 3 12/17/21 20220101 NES 220101 Diclofenac (CAS 15307-86-5) is a widely used non-steroidal anti-inflammatory drug (NSAID). [Extracted from the article]

Case report, fixed drug eruption, fluconazole, drug patch testing Keywords: case report; drug patch testing; fixed drug eruption; fluconazole EN case report drug patch testing fixed drug eruption fluconazole 350 352 3 04/07/21 20210501 NES 210501 Fluconazole, a triazole antifungal agent, is commonly used in the treatment of vulvovaginal candidiasis.1 Whilst fluconazole is rarely associated with fixed drug eruptions (FDE), some cases have been reported in the literature.1,2 In FDE, patch testing has reported utility,3 and is conventionally performed on residual pigmented lesional sites.4 In this case report of bullous FDE induced by fluconazole, we report on the value of multi-site lesional patch testing in safely establishing the diagnosis. Bullous fixed drug eruption induced by fluconazole: Importance of multi-site lesional patch testing. [Extracted from the article]

In another adult patient case, perennial rhinitis, confirmed by a placebo-controlled provocation, was detected and related to SB-containing wine and cheese.9 SB-induced pruritus may also develop due to its use as a food additive.10 In the present case there was no systemic reaction following oral SB intake, but only an acute, transient, urticarial face rash, likely indicating nonimmunologic contact urticaria. The patient's parents were instructed to avoid skin contact with the drug, and the girl was able to continue the oral intake of the remaining SB doses without any further skin reactions and systemic reactions. Keywords: case report; child; drug allergy; sodium benzoate EN case report child drug allergy sodium benzoate 40 41 2 12/17/21 20220101 NES 220101 Sodium benzoate (SB) is an additive typically used in the food industry for colouring, sweetening, and antimicrobial effects, whereas in the pharmaceutical industry it is often used as a preservative (eg, in cough syrups, vitamin preparations, heparins, and antibiotic syrups).1 In addition, SB is a basic medication for certain paediatric metabolic diseases; for example, in urea cycle defects, SB is used to decrease ammonia.2 A variety of immunoglobulin E and non-immunoglobulin E-mediated reactions from SB have been reported in the literature. [Extracted from the article]

Background Antiretroviral drug hypersensitivity in HIV patients is common. Publications have shown that Abacavir ( ABC) patch testing is useful in confirming ABC hypersensitivity in 24-50% of cases with a 100% sensitivity of HLA- B*5701 in patch test positive cases. However, Nevirapine ( NVP) patch testing has not been reported. Objectives (1) To evaluate the usefulness and safety of NVP patch testing in Thai HIV patients with NVP hypersensitivity. (2) To assess the correlation of positive patch tests with HLA- B*3505. Patients and methods Patients were classified into two groups: (1) study group of 20 HIV NVP hypersensitivity patients and (2) control group of 15 volunteers without NVP hypersensitivity. Both groups were patch tested with purified and commercialized form of NVP in various vehicles. Results Two HIV patients with NVP hypersensitivity were patch test positive. All controls tested negative. Three HIV patients were positive for HLA- B*3505 and the two patients with positive patch testing were both HLA-B*3505 positive. Conclusions NVP patch testing in Thai HIV patients is safe and can be used to help confirm the association between NVP and hypersensitivity skin reactions. NVP patch test results significantly correlated with HLA-B*3505. The sensitivity of HLA-B*3505 for positive patch test was 100%. [ABSTRACT FROM AUTHOR]

Evaluates the value of patch tests in pristinamycin-induced drug eruptions. Cutaneous manifestations of drug-induced allergy; Absence of relapse of the drug eruption during patch testing; Reliability and accuracy of patch tests.

Background Adverse drug reactions pose an increasing diagnostic challenge in hospitals and in outpatient clinics. When consecutive or repeated allergic drug eruptions are suspected, patch testing is a useful diagnostic tool for determining the causative drugs. Objectives The aim of the study was to identify patient cases with multiple delayed-type drug sensitizations by using patch testing. Methods Eight hundred and eleven patients with suspected drug allergy were patch tested during a 9-year period. Results Multiple delayed drug sensitizations were found in 12% of those patients with positive results in drug patch testing. Conclusions Drug patch testing is useful in cutaneous adverse drug reactions where multiple drugs are suspected. Multiple drug sensitizations can be found in a proportion of patients who have delayed drug allergies. In addition to drug reactions with eosinophilia and systemic symptoms, these patients may have repeated exanthemas or contact dermatitis. [ABSTRACT FROM AUTHOR]

Background: In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients. Objective: The aim of the present study is to evaluate the safety and usefulness of patch testing in DRESS. Patients/Methods: Between January 1998 and December 2008, we studied 56 patients with DRESS induced by antiepileptic agents in 33 patients (59%), allopurinol in 19 (34%) and sulfasalazine, cotrimoxazole, tenoxicam, and amoxicillin in 1 patient each (7%). Results: A positive patch test reaction was observed in 18 patients (32.1%), of which 17 were with antiepileptics and 1 with tenoxicam. In the antiepileptic group, carbamazepine alone was responsible for 13 of 17 positive reactions (76.5%). Patch tests with allopurinol and its metabolite were negative in all cases attributed to this drug. Conclusions: In this study, patch testing was a safe and useful method in confirming the culprit drug in DRESS induced by antiepileptic drugs, whereas it had no value in DRESS induced by allopurinol. The pathogenesis of DRESS is not yet entirely clarified, but positive patch tests suggest a drug-dependent delayed hypersensitivity mechanism. [ABSTRACT FROM AUTHOR]

The article presents a case study on occupational airborne contact dermatitis from pristinamycin. Pristinamycin is categorized as an antibiotic under the streptogramin group. The drug was said to have caused various cutaneous side reactions in patients. The reactions were due to ingestion of the medicament, presenting as maculopapular eruption, erythroderma, angioedema, and Stevens-Johnson syndrome.

Reports on the case of a 39-year-old woman who presented with cutaneous adverse reaction to oral chlorphenamine in Great Britain. Dosage of Piriton taken by the patient for insect bite reactions; Development of erythematous rash on the trunks and limbs; Confirmation of contact allergy by patch testing.

Presents a case study of an aged patient diagnosed with a certain disease and treated with flutamide. Usefulness of photopatch testing in the investigation of photosentivity due to flutamide; Side effects of flutamide; Criteria for the basis of considering the case to be a photosensitivty reaction induced by flutamide.

Discusses a case of erythrodermic cutaneous adverse drug reaction to oral pseudoephedrine. Case of a 44-year-old Caucasian woman with acute generalized blistering erythrodermic dermatitis; Ingestion of combination of acrivastine and pseudoephedrine hydrochloride for allergic rhinitis; Mild superficial dermal mononuclear infiltrate.