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Background Objectives Methods Results Conclusion Patch tests (PTs) are recommended to identify the culprit drug in non‐immediate cutaneous adverse drug reactions (NICADRs). We recently reported that, in patients with NICADRs, a unique reading of PTs at day (D)2 compared with an additional second late reading at D4 missed almost half (45.3%) of the positive PTs.To assess the change in sensitivity of the PT reading on D4 compared with the reading on D3.We performed a retrospective (July 2020–June 2023) monocentric study of patients who had PTs with two readings for a NICADR. We compared reading on D3 and the second reading on D4 for the suspected drug (primary outcome) and for the related drugs tested simultaneously (secondary outcome).During the study period, 249 patients underwent patch testing with D3 and D4 readings. Regarding the primary outcome, the first reading at D3 was positive for 13.7% of patients, and the reading at D4 for 24.9% of patients (p < 0.0001). Regarding the secondary outcome, only 9.6% of patients had all their positive PT at D3 compared with 24.9% of patients at D4 (p < 0.0001). Considering the evaluated drug classes, no statistical difference was observed. However, we highlight that D3 reading detected all positive carbamazepine PTs (n = 3) while positive clindamycin PTs (n = 4) were identified only with the help of the second reading on D4.This study showed that, an additional D4 reading compared with a single D3 reading enhanced the sensitivity of PTs to identify culprit drugs and related. Further studies should replicate these findings and evaluate the medico‐economic balance and safety of a single reading of PTs on D4. [ABSTRACT FROM AUTHOR]

Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions (CADRs), and determining safer, alternative drugs. PTs have a low sensitivity but are valuable in investigating maculopapular exanthema (MPE), as well as severe CADR, including toxic epidermal necrolysis (TEN), Stevens‐Johnson syndrome (SJS), and in particular, acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). To ensure their specificity, at least 10 control tests should be performed. Prick tests are mainly used in the evaluation of immediate‐type hypersensitivity and can be performed with all drugs, except opiates. IDTs can be used to explore immediate and delayed‐type hypersensitivity, if an injectable form of the drug exists. Except for SJS/TEN, IDTs should be performed by injecting 0.02 mL of the drug. We here provide a practical, up‐to‐date review on the use of these skin tests in the work‐up of CADRs. Numerous negative controls for drug PTs, as well as criteria for the immediate and delayed positivity of prick tests and IDT, are included. It should be emphasized that a negative result never excludes the potential responsibility of a drug in a CADR. [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]

Keywords: 4-phenylenediamine; dermatitis; allergic contact; drug-related side effects and adverse reactions; immunotherapy; patch tests EN 4-phenylenediamine dermatitis allergic contact drug-related side effects and adverse reactions immunotherapy patch tests 377 379 3 09/08/22 20221001 NES 221001 Abbreviations ACD allergic contact dermatitis CTLA-1 cytotoxic T-lymphocyte associated protein 4 ICP immune check points ICPI immune check point inhibitor IRAE immune-related adverse events MI methylisothiazolinone PD-1 programmed cell death protein 1 PDL1 programmed death ligand 1 PPD para-phenylenediamine Treg T regulatory cells Allergic contact dermatitis (ACD) arising during immune check point inhibitor (ICPI) therapy has rarely been reported and is likely an under-recognized cause of a number of cutaneous immune-related adverse events (IRAE), especially treatment refractory dermatitic eruptions. Dermatitis, allergic contact, drug-related side effects and adverse reactions, 4-phenylenediamine, immunotherapy, patch tests Just as immunosuppression risks false-negative results,7 an immune-enhanced anti-PD-1 state could theoretically cause allergy induction, severe patch test reactions and false positives. [Extracted from the article]

Generalized bullous fixed drug eruption (GBFDE) is a specific variant of fixed drug eruption that belongs to severe cutaneous adverse reactions (SCARs) and its diagnosis is based mainly on clinical course and especially on the reoccurrence of typical bullous lesions in previous and new sites after re-administration of the offending drug. We present a well-documented case of fluconazole-induced GBFDE, with a positive patch test to fluconazole (30% weight/volume preparation) and clinical tolerance to itraconazole proven by negative oral provocation. Even in SCARs, patch testing represents a useful diagnostic tool, while oral provocation remains the gold standard in cases that an alternative but the chemically relevant drug must be administered. [ABSTRACT FROM AUTHOR]

Background: Data on the cutaneous side effects of herbal medicine is scarce, especially with regard to allergy skin testing. Our objective was to determine the relevancy of patch testing in the exploration of the cutaneous side effects of herbal medicine. Material and Methods: A prospective study was conducted in the Department of Dermatology of the Hospital Institute of Social Hygiene of Dakar over a one-year period. Patch tests were given to patients with cutaneous side effects related to the exclusive use of herbal medicine. The plants recovered were turned into macerates and powders and mixed with Vaseline at concentrations of 5%, 20%, and 30%. Results: Patch tests were given to 31 of the 53 patients included. They were positive in 11 patients (35.48%). Positive patients displayed systemic eczema (n = 7/15 of cases), Stevens--Johnson syndrome (n = 2/3), contact eczema (n = 1/1), and fixed pigmented erythema (n = 1/2). Positive tests were obtained for 11 medicinal plants identified: Jatropha chevalieri (n = 2), Terminalia avicennoïde (n = 2), Detarium microcarpum, Acacia seyal, Acacia albida, Acacia italic, Sesamum indicum, Mangifera indica, Momordica charantia, Nauclea latifolia, and Anogeisius leiocarpus (in one case each). There was no statistically significant relationship between the type of cutaneous side effect and the test result (p = 0.388) and between the nature of the plant used and the test result (p = 0.402). Conclusion: In view of their high rates of positivity, patch tests could prove promising in the exploration of the cutaneous side effects of herbal medicine. [ABSTRACT FROM AUTHOR]

Introduction: : Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction. According on the culprit drug(s), imputability can be confirmed by patch test (PT). Our objective was to evaluate the value of PT in DRESS in the last 10 years, in comparison with our study in the preceding 10 years. Material & Methods: From 2009 to 2018, patients with DRESS performed PT at the Dermatology Department of Coimbra University Hospital, with the main culprit drug(s) and all drugs administered concomitantly or suspected of inducing DRESS flares. Drugs at 1% - 10% pet (Chemotechnique diagnostics®) or from a commercial preparation diluted at 10% pet were patch tested. Results: We studied 41 patients (20 male/21 female, mean age 53 years). The main culprits were allopurinol (n=15), antiepileptics (n=14), trimethoprim/ sulfamethoxazole (n=4), salazopyrine (n=3), diclofenac (n=2), antiretrovirals, ezetimibe/simvastatin and strontium ranelate (1 each). In 15 patients other drugs (n=18) were suspected of worsening DRESS, amoxicillin (n=8), ciprofloxacin (n=2), cefoxitin (n=2), levofloxacin, ceftriaxone, ceftazidime, vancomycin, acyclovir and metamizole (1 each). A positive PT to the culprit drug was observed in 10 patients (24.3%), all to antiepileptics. All patients tested for alopurinol had negative results. Positive reactions were observed to drugs related with flares in 12/18 suspected drugs (67%), but not to quinolones. Conclusion: Results were similar to the study conducted 10 years before when 18/56 (32.1%) patients had positive PT, mostly to carbamazepine and other anticonvulsants. Distinct from our previous study, when no tests were performed with the antibiotic series or other drugs used after the initiation of DRESS, we showed that PT can be a valuable tool to diagnose co-sensitisation in DRESS and emphasise the importance of testing all medications taken during the whole episode, even when PT has no value for the main culprit, like allopurinol. Recognising a co-sensitisation can prevent a new DRESS induced by the second drug. [ABSTRACT FROM AUTHOR]

Background: Patients suffering from drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome caused by first‐line antituberculosis drugs often need to be retreated rapidly. Patch tests prior to the reintroduction of antituberculosis drugs are rarely performed. Objectives: To highlight those drugs most often involved in DRESS caused by antituberculosis drugs, illustrate the potential value of patch tests to identify these culprit(s), and provide insights into how to rapidly retreat these patients. Methods: A detailed description of the work‐up of two illustrative patients, together with a literature review of similar cases, is provided. Results: All first‐line antituberculosis drugs may cause DRESS syndrome, but rifampicin and isoniazid are most frequently involved. Patch tests can be performed sooner than usually advised in the context of DRESS syndrome, and potentially with lower test concentrations, but false‐negative results are possible. Sequential reintroduction of patch test‐negative drugs is feasible, although the dose and order of drugs to be readministered, as well as the use of concomitant systemic corticosteroids, remain a matter of debate. Conclusion: Patch tests in the context of DRESS syndrome caused by antituberculosis drugs, despite their shortcomings, may potentially guide rapid retreatment of these patients. [ABSTRACT FROM AUTHOR]

Case report, cetirizine, cutaneous adverse drug reaction, fixed drug eruption, hydroxyzine, levocetirizine, patch tests Keywords: case report; cetirizine; cutaneous adverse drug reaction; fixed drug eruption; hydroxyzine; levocetirizine; patch tests EN case report cetirizine cutaneous adverse drug reaction fixed drug eruption hydroxyzine levocetirizine patch tests 318 319 2 03/15/23 20230401 NES 230401 Fixed drug eruption (FDE) is a cutaneous adverse drug reaction most frequently caused by non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, anticonvulsants, or paracetamol.[1] Uncommonly, cetirizine and other H1 antihistamines have also been implicated in FDE.[[2]] We report a case of cetirizine-induced FDE with cross-reaction with other piperazine derivatives confirmed by patch test. 2 Cravo M, Gonçalo M, Figueiredo A. Fixed drug eruption to cetirizine with positive lesional patch tests to the three piperazine derivatives. [Extracted from the article]

Acute generalized exanthematous pustulosis following paracetamol ingestion in a 5-year-old child: A case report According to the literature, tests can be positive in up to 58% of the patients.3 Some selected allergens from the European baseline series, propolis syrup ("as is"), amoxicillin 10% pet., acetaminophen (paracetamol) 10% pet. and ibuprofen 10% pet. were tested. Keywords: acute generalized exanthematous pustulosis; case report; children; paediatrics; paracetamol; patch tests EN acute generalized exanthematous pustulosis case report children paediatrics paracetamol patch tests 290 291 2 08/16/22 20220901 NES 220901 Acute generalized exanthematous pustulosis (AGEP) is a severe skin condition characterized by an acute onset of a widespread erythematous eruption with non-follicular, sterile pustules, in association with fever. [Extracted from the article]

Sympathomimetic drug allergy: cross-reactivity study by patch test. Keywords: case report; cross-reactivity; maculopapular eruption; patch tests; phenylephrine; pseudoephedrine; sympathomimetics EN case report cross-reactivity maculopapular eruption patch tests phenylephrine pseudoephedrine sympathomimetics 716 717 2 11/18/21 20211201 NES 211201 INTRODUCTION Pseudoephedrine (P-eph) is a sympathomimetic drug and a stereoisomer of ephedrine. Case report, cross-reactivity, phenylephrine, patch tests, maculopapular eruption, pseudoephedrine, sympathomimetics. [Extracted from the article]

Keywords: COVID-19; DRESS syndrome; hydroxychloroquine; patch tests EN COVID-19 DRESS syndrome hydroxychloroquine patch tests 50 51 2 12/11/20 20210101 NES 210101 Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, (formerly known as drug-induced hypersensitivity syndrome) is an acute, idiosyncratic, and potentially life-threatening drug reaction, characterized by fever (>38.5°C), skin eruptions, and haematological abnormalities.1 The most frequently involved drugs are anticonvulsants, sulfonamides, allopurinol, and antibiotics,2 while hydroxychloroquine has been rarely reported as causative agent.2,3 CASE REPORT A 37-year-old woman consulted the emergency department for itchy rash, facial edema, and fever (38.5°) developing in the course of 2 days. Hydroxychloroquine is considered to be safe and side-effects are generally mild and transitory.5 The most common adverse effect of hydroxychloroquine is a a skin rash; however, in our patient, DRESS syndrome caused by hydroxychloroquine was diagnosed, based on patch testing that proved useful for identifying the causative drug in this patient.6 In conclusion, we have presented the first case of DRESS syndrome due to hydroxychloroquine with a positive patch test. [Extracted from the article]

The present review addresses the literature regarding the sensitivity and specificity of the various diagnostic methods for evaluating non-immediate (ie, occurring more than 1 hour after drug administration) hypersensitivity reactions associated with ß-lactams and other antibiotics, anticonvulsants, heparins, iodinated contrast media, etc. Such reactions include several clinical entities, which range from mild reactions, such as maculopapular rash and delayed-appearing urticaria, to severe ones, such as acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN). Clinical and laboratory studies indicate that a cell-mediated pathogenic mechanism is often involved in maculopapular rashes. However, this mechanism has also been demonstrated in other non-immediate reactions, such as urticarial and/or angioedematous manifestations, TEN, bullous exanthems, and AGEP. Patch tests, together with delayed-reading intradermal tests, lymphocyte transformation tests, and challenges, are useful tools for evaluating non-immediate drug eruptions. Patch tests can be performed with any form of commercial drugs and are safer than intradermal tests. However, patch tests are less sensitive than intradermal tests, and their sensitivity may vary, depending on the vehicle used. [ABSTRACT FROM AUTHOR]

Drug skin tests can be helpful in determining the cause of a cutaneous adverse drug reaction (CADR). Patch tests and prick tests can be performed with any commercialized form of a drug. Intradermal tests (IDTs) have a greater value, but their techniques have not been standardized. Moreover, IDTs can be done only if an injectable form of the drug is commercialized and are restricted to patients with nonsevere CADR. Prick tests and IDTs are used in investigating immediate hypersensitivity. Patch tests both with IDTs with delayed readings are helpful for maculopapular rash and generalized or localized eczema. Results obtained with drug skin tests in β-lactam sensitization have been extensively published, but fortunately, during the last few years the value of skin tests in CADR due to other drug classes (e.g., synergistins, platinium salts or radiocontrast medias) was also studied. The analysis of recent literature permits to propose which tests to choose for each clinical feature of CADR and to give the list of all drugs, having had patch tests with positive results but, emphasizes the lack of standardization in performing and reading IDTs. This standardization is absolutely necessary to determine the thresholds of specificity of the IDT. Except for IDTs, drug skin tests induce only rarely adverse reactions. False-positive results can occur and should be considered by testing new products. The negative predictive value of drug skin tests is a crucial point that will have to be studied in more detail in the near future. [ABSTRACT FROM AUTHOR]

Safe use of imipenem after delayed hypersensitivity to meropenem - Value of patch tests Avoiding a carbapenem can be life-threatening in the absence of an effective alternative, because these drugs are among the few antibiotics effective against an extended spectrum of -lactamase-producing organisms. Our study supports the absence of cross-reactivity in patients with cell-mediated allergy to carbapenems and reinforces that patients with allergy to meropenem should undergo patch test with imipenem and if results are negative there is no contraindication to use this drug. [Extracted from the article]

Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1% of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2%). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients – 93 of whom had experienced maculopapular rashes – displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article present a case study of a 47-year-old woman presented with annular erythematous plaques with vesicles and pustules. Topics discussed include the patient reported sporadic self-medication with several non-steroidal anti-inflammatory drugs; mentions histological assessment of a skin biopsy was compatible with a bullous skin drug reaction; and also mentions the drug reaction caused by ibuprofen was confirmed by positive patch test results.

The article presents case studies related to skin eruption caused by etoricoxib. It discusses the case study of a 69-year-old female with erythematous pruriginous patches occuring simultaneously in various parts of her body 1 day after taking 60 milligrams of etoricoxib for her fever. It also features the case of a 63-year-old female with osteoarthritis who presented with skin lesions in various parts of her body after intake of nonsteroidal anti-inflammatory drug for her joint pains.

Patch testing may help to assess the culpability of a drug in an adverse reaction. Our aim was to study patch testing in severe cutaneous adverse drug reactions (ADRs) (Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP), and other cutaneous ADRs). 59 patients with cutaneous ADRs were included: 22 had SJS/TEN, 14 AGEP, and 23 other cutaneous ADRs. Patients were patch tested with the suspect drug, and with a standard series of drugs. 2 patients among the 22 SJS/TEN cases had a relevant positive test. 7 patients among the 14 AGEP cases had a relevant positive test. 6 patients among the 23 other cutaneous ADRs had a relevant positive test. Our results suggest that patch testing has a weak sensitivity in SJS/TEN and is not appropriate in these diseases. Patch testing seems more adapted to other cutaneous ADRs, such as AGEP, in which the proportion of positive patch tests was significantly higher (p<0.02). Nevertheless, the difference of sensitivity of patch testing in SJS/TEN. AGEP or other cutaneous ADRs could be linked not only to the clinical type of eruption, but also to the different spectrum of culprit drugs in each type of eruption. [ABSTRACT FROM AUTHOR]

The article presents a case study of female patient with superficial perivascular lymphocytic dermatitis with some eosinophil and some lymphocyte permeation in the epidermis. Patch test confirmed reaction due to pregabalin, and suggested alternative drug Lacosamide.

Presents a case study of an aged woman who developed drug-induced papulovesicular exanthema. Findings of skin tests administered to the patient; Clinical manifestations of drug-induced papulovesicular exanthema; Pathogenesis of drug-induced papulovesicular exanthema.

Examines cases of cutaneous reactions to piperacillin (PP) caused by delayed hypersensitivity. Evaluation on the adverse reactions in patients affected by cystic fibrosis; Administration of avocin during the postperiod period; Determinants of reactions to PP.