Utility and safety of skin tests in drug reaction with eosinophilia and systemic symptoms (DRESS): a systematic review
Utility and safety of skin tests in drug reaction with eosinophilia and systemic symptoms (DRESS): a systematic review
Background: determination of culprit drug in drug reaction with eosinophilia and systemic symptoms (DRESS) is crucial. Skin tests have been used, although it remains unclear how sensitive these are.
Objective: to determine the value of skin tests in the assessment of drug causality in DRESS.
Methods: a systematic literature search was conducted for publications from 1996 onward of skin tests (skin prick test = SPT, patch test = PT, intradermal test = IDT) performed in clearly defined DRESS cases. Outcomes of testing, drug culpability assessments, and challenge test data were extracted.
Results: a total of 17 articles met inclusion criteria. In 290 patients with DRESS, patch testing was most frequent (PT = 97.2% [n = 282], IDT = 12.4% [n = 36], SPT = 3.1% [n = 9]). Positive results were noted in 58.4% (n = 160 of 282) of PTs, 66.5% of IDTs, and 25% of SPTs. When confidence of drug causality was high (n = 73 of 194), testing did not correlate well with clinical suspicion: PTs, 37.6%; IDTs, 36.5%. Direct comparison of skin testing with provocation testing (n = 12) showed 83.3% correlation. Positive IDT results were reported in 8 negative PT cases.
Conclusions: skin tests, particularly PTs and IDTs, have been reported as tools for diagnosis of causal drugs in DRESS. Heterogeneity in methodology, results analysis, and reporting of cohorts make meta-analysis to determine sensitivity and specificity of published literature impossible and highlight weaknesses in the field. We propose that international collaboration is essential to harmonize the methodology and reporting measures from hypersensitivity testing studies in larger cohorts.
Drug patch tests, Drug reaction with eosinophilia and systemic symptoms, Intradermal test, Skin prick test
481-491.e5
Teo, Ying Xin
a9478dfb-fcbd-4e68-b5ee-00a5bfd564b4
Friedmann, Peter Simon
d50bac23-f3ec-4493-8fa0-fa126cbeba88
Polak, Marta Ewa
e0ac5e1a-7074-4776-ba23-490bd4da612d
Ardern-Jones, Michael Roger
7ac43c24-94ab-4d19-ba69-afaa546bec90
7 February 2023
Teo, Ying Xin
a9478dfb-fcbd-4e68-b5ee-00a5bfd564b4
Friedmann, Peter Simon
d50bac23-f3ec-4493-8fa0-fa126cbeba88
Polak, Marta Ewa
e0ac5e1a-7074-4776-ba23-490bd4da612d
Ardern-Jones, Michael Roger
7ac43c24-94ab-4d19-ba69-afaa546bec90
Teo, Ying Xin, Friedmann, Peter Simon, Polak, Marta Ewa and Ardern-Jones, Michael Roger
(2023)
Utility and safety of skin tests in drug reaction with eosinophilia and systemic symptoms (DRESS): a systematic review.
Journal of Allergy and Clinical Immunology: In Practice, 11 (2), .
(doi:10.1016/j.jaip.2022.09.011).
Abstract
Background: determination of culprit drug in drug reaction with eosinophilia and systemic symptoms (DRESS) is crucial. Skin tests have been used, although it remains unclear how sensitive these are.
Objective: to determine the value of skin tests in the assessment of drug causality in DRESS.
Methods: a systematic literature search was conducted for publications from 1996 onward of skin tests (skin prick test = SPT, patch test = PT, intradermal test = IDT) performed in clearly defined DRESS cases. Outcomes of testing, drug culpability assessments, and challenge test data were extracted.
Results: a total of 17 articles met inclusion criteria. In 290 patients with DRESS, patch testing was most frequent (PT = 97.2% [n = 282], IDT = 12.4% [n = 36], SPT = 3.1% [n = 9]). Positive results were noted in 58.4% (n = 160 of 282) of PTs, 66.5% of IDTs, and 25% of SPTs. When confidence of drug causality was high (n = 73 of 194), testing did not correlate well with clinical suspicion: PTs, 37.6%; IDTs, 36.5%. Direct comparison of skin testing with provocation testing (n = 12) showed 83.3% correlation. Positive IDT results were reported in 8 negative PT cases.
Conclusions: skin tests, particularly PTs and IDTs, have been reported as tools for diagnosis of causal drugs in DRESS. Heterogeneity in methodology, results analysis, and reporting of cohorts make meta-analysis to determine sensitivity and specificity of published literature impossible and highlight weaknesses in the field. We propose that international collaboration is essential to harmonize the methodology and reporting measures from hypersensitivity testing studies in larger cohorts.
Text
DRESS skin_test_corrections_clean
- Accepted Manuscript
More information
Accepted/In Press date: 11 September 2022
e-pub ahead of print date: 22 September 2022
Published date: 7 February 2023
Additional Information:
Funding Information:
This work was supported by the British Skin Foundation (grant no. BSF8021).
Publisher Copyright:
© 2022 American Academy of Allergy, Asthma & Immunology
Keywords:
Drug patch tests, Drug reaction with eosinophilia and systemic symptoms, Intradermal test, Skin prick test
Identifiers
Local EPrints ID: 474187
URI: http://eprints.soton.ac.uk/id/eprint/474187
ISSN: 2213-2198
PURE UUID: bb4d8246-0892-4fcc-a857-315a8c0b083b
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Date deposited: 15 Feb 2023 17:32
Last modified: 17 Mar 2024 07:33
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Contributors
Author:
Ying Xin Teo
Author:
Peter Simon Friedmann
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