Survey of Drug Allergy Testing, Challenge, and Desensitization Practice

Joseph Hb

doi:10.4172/2161-0495.1000136

Abstract

Background: The lack of standardized skin test products to determine a patient’s (hyper-) sensitivity to medications has required physicians to empirically develop their own testing procedures. These approaches include puncture and intradermal skin tests, patch tests and medication challenges. Desensitization protocols are also frequently used when the necessity of a particular medication is urgent. Objective: This study surveyed drug hypersensitivity testing and desensitization practices reported in 3 allergy journals, over a 5-year period 2004-2008. Methods: This survey collected reports of skin tests, challenges, and desensitization to medications, vaccines, and diagnostic agents in 3 leading allergy journals. Studies were included if they reported sufficient detail that the reader could reasonably be expected to reproduce the technique reported. We did not include reports of in vitro testing because the ability of the individual practitioner to perform these tests may be limited. Results: Data for 191 drugs were sufficiently detailed to include. Testing with antimicrobial agents was reported most frequently; and several newer classes of medications such as monoclonal antibodies and interferons are also included. Skin testing to detect medication allergy was the most commonly reported technique; however there were numerous drug challenge and drug desensitization schedules used in practice. Conclusion: Beyond testing for medications such as antibiotics, corticosteroids and local anesthetics skin testing, challenge, and desensitization schedules have been described for numerous other medication classes. The variety of these schedules is likely driven both by the needs of clinical practice and the lack of standardized skin test preparations.

Highlights

Each year, the release of new drugs, as well as the approval of novel uses of older drugs by the US Food and Drug Administration, increases the potential for adverse reactions to medications
Skin testing to detect medication allergy was the most commonly reported technique; there were numerous drug challenge and drug desensitization schedules used in practice
Beyond testing for medications such as antibiotics, corticosteroids and local anesthetics skin testing, challenge, and desensitization schedules have been described for numerous other medication classes

Summary

Introduction

The release of new drugs, as well as the approval of novel uses of older drugs by the US Food and Drug Administration, increases the potential for adverse reactions to medications. In the United States, only one commercial product is approved for detecting immediate drug hypersensitivity (Pre-Pen [benzylpenicilloyl polylysine], AllerQuest LLC, West Hartford, Connecticut). This has left a gap in our ability to predict or confirm the potential ability of medications to cause lifethreatening reactions. The lack of standardized skin test products to determine a patient’s (hyper-) sensitivity to medications has required physicians to empirically develop their own testing procedures. These approaches include puncture and intradermal skin tests, patch tests and medication challenges. Desensitization protocols are frequently used when the necessity of a particular medication is urgent

Methods

Results

Discussion

Conclusion