Advanced searchCitation search
Skip main navigation
Close Drawer MenuOpen Drawer Menu
Articles15 June 2004

Drug Provocation Tests in Patients with a History Suggesting an Immediate Drug Hypersensitivity Reaction

    Author, Article, and Disclosure Information
    https://doi.org/10.7326/0003-4819-140-12-200406150-00009
    Background:

    Drug hypersensitivity reactions are common and can be life-threatening. Confirmation of the diagnosis should be rigorous and based on clinical history and a physical examination, possibly followed by skin tests and drug provocation tests.

    Objective:

    To describe the outcome of drug provocation tests in evaluating patients with histories suggesting drug allergy.

    Design:

    Retrospective analysis of clinic case series.

    Setting:

    The department for drug allergy at a university hospital.

    Patients:

    898 consecutive patients with suspected immediate drug allergy referred to the clinic between September 1996 and August 2001. Patients with severe skin reactions and those with positive results on skin tests for β-lactams were excluded.

    Intervention:

    Single-blinded administration of increasing doses of the suspected drug, up to the usual daily dose, under strict hospital surveillance.

    Results:

    1372 drug provocation tests were performed using various drugs, including β-lactams (30.3%), aspirin (14.5%), other nonsteroidal anti-inflammatory drugs (11.7%), paracetamol (8.9%), macrolides (7.4%), and quinolones (2.4%). There were 241 (17.6%) positive drug provocation test results. Drug provocation reproduced the same symptoms, albeit milder and of a shorter duration, in the following patients: 13 (5.4%) with a history of anaphylactic shock, 17 (7.0%) with a history of anaphylaxis without shock, 10 (4.1%) with a history of laryngeal edema, 19 (7.9%) with a history of bronchospasm, 160 (66.4%) with a history of urticaria, and 22 (9.1%) with a history of maculopapular eruption. All adverse reactions were completely reversed by prednisolone, H1-antihistamines, and epinephrine as needed.

    Limitations:

    Falsely negative results on drug provocation tests may have occurred because of loss of sensitization, rare cofactors not included in the diagnostic procedure, and tolerance induction during provocation.

    Conclusions:

    Drug provocation tests in individuals with suspected drug allergy performed in carefully controlled settings can confirm drug hypersensitivity.

    References

    • 1. Demoly P, Bousquet J. Epidemiology of drug allergy. Curr Opin Allergy Clin Immunol. 2001;1:305-10. [PMID: 11964705] CrossrefMedlineGoogle Scholar
    • 2. Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, et al . A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56:813-24. [PMID: 11551246] CrossrefMedlineGoogle Scholar
    • 3. Gruchalla RS. Clinical assessment of drug-induced disease. Lancet. 2000;356:1505-11. [PMID: 11081549] CrossrefMedlineGoogle Scholar
    • 4. Primeau MN, Adkinson NF. Recent advances in the diagnosis of drug allergy. Curr Opin Allergy Clin Immunol. 2001;1:337-41. [PMID: 11964709] CrossrefMedlineGoogle Scholar
    • 5. Demoly P, Bousquet J. Drug allergy diagnosis work up. Allergy. 2002;57 Suppl 72 37-40. [PMID: 12144553] CrossrefMedlineGoogle Scholar
    • 6. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al . Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003;58:854-63. [PMID: 12911412] CrossrefMedlineGoogle Scholar
    • 7. Stevenson DD. Challenge procedures in detection of reactions to aspirin and nonsteroidal anti-inflammatory drugs. Ann Allergy. 1993;71:417-8. [PMID: 8250345] MedlineGoogle Scholar
    • 8. Dahlen B, Szczeklik A, Murray JJ. Celecoxib in patients with asthma and aspirin intolerance. The Celecoxib in Aspirin-Intolerant Asthma Study Group [Letter]. N Engl J Med. 2001;344:142. [PMID: 11188419] CrossrefMedlineGoogle Scholar
    • 9. Torres MJ, Mayorga C, Leyva L, Guzman AE, Cornejo-Garcia JA, Juarez C, et al . Controlled administration of penicillin to patients with a positive history but negative skin and specific serum IgE tests. Clin Exp Allergy. 2002;32:270-6. [PMID: 11929493] CrossrefMedlineGoogle Scholar
    • 10. Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002;57:45-51. [PMID: 11991289] MedlineGoogle Scholar
    • 11. Demoly P, Kropf R, Bircher A, Pichler WJ. Drug hypersensitivity: questionnaire. EAACI interest group on drug hypersensitivity. Allergy. 1999;54:999-1003. [PMID: 10505466] CrossrefMedlineGoogle Scholar
    • 12. Kvedariene V, Bencherioua AM, Messaad D, Godard P, Bousquet J, Demoly P. The accuracy of the diagnosis of suspected paracetamol (acetaminophen) hypersensitivity: results of a single-blinded trial. Clin Exp Allergy. 2002;32:1366-9. [PMID: 12220477] CrossrefMedlineGoogle Scholar
    • 13. Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, et al . Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med. 1995;333:1600-7. [PMID: 7477195] CrossrefMedlineGoogle Scholar
    Previous
    Next

    Submit a Comment

    Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
    *All comments submitted after October 1, 2021 and selected for publication will be published online only.
    Cancel