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Giornale Italiano di Dermatologia e Venereologia 2020 Sep 17

DOI: 10.23736/S0392-0488.20.06698-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Skin tests in the diagnosis of adverse drug reactions: a systematic review

Luca STINGENI 1, Leonardo BIANCHI 1 , Marta TRAMONTANA 1, Paolo D. PIGATTO 2, Cataldo PATRUNO 3, Monica CORAZZA 4, Caterina FOTI 5, Gabriella FABBROCINI 6, Giuseppe MICALI 7, Paolo ROMITA 5, Maddalena NAPOLITANO 8, Katharina HANSEL 1

1 Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy; 2 Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy; 3 Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy; 4 Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; 5 Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy; 6 Department of Dermatology, University of Naples Federico II, Naples, Italy; 7 Dermatology Clinic, P.O.G. Rodolico, A. O.U. Policlinico Vittorio Emanuele, Catania, Italy; 8 Department oh Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy


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Adverse Drug Reactions (ADRs) are common and influence negatively the patient’s therapeutic options. They recognize multiple pathogenic mechanisms, some of immunological origin, and the clinical manifestations involve several organs and systems, including skin and/or mucous membranes in 25-30% of patients. The identification of the trigger drug remains a medical challenge, mainly in poly-medicated patients. Anamnesis and clinical approach are crucial, but allergy work-up is the essential tool to confirm or exclude the causative role of the culprit drug. Besides in vitro tests and drug provocation test, skin tests (ST) represent the cornerstone: patch test in delayed ADR, prick test in immediate ADR, and intradermal test in both. Nevertheless, ST are in continuous evolution and characterized by technical difficulties (concentration and vehicle) that can influence their value and specificity. In this article we review the indications and the rules in performing patch test, prick test, and intradermal test with the most commonly used drugs in Italy to determine the cause of a cutaneous and/or mucous ADR, precise the involved pathogenic mechanism, and provide a valid therapeutic alternative to the patient.


KEY WORDS: Adverse drug reaction; Patch test; Prick test; Intradermal test; Skin test; Review

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