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Matei I, Bettuzzi T, Weill A, Gener G, Hareth KB, Margaux F, Verlinde-Carvalho M, Paul M, Ingen-Housz-Oro S, Assier H. Patch tests in non-immediate cutaneous adverse drug reactions: Late readings on Day 4 is more sensitive than on Day 3. Contact Dermatitis 2024. [PMID: 39078104 DOI: 10.1111/cod.14654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND 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. OBJECTIVES To assess the change in sensitivity of the PT reading on D4 compared with the reading on D3. METHODS 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). RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ilaria Matei
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Thomas Bettuzzi
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
- EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
| | - Amandine Weill
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Gwendeline Gener
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Kamar Bel Hareth
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Fleck Margaux
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | | | - Muriel Paul
- EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France
- Department of Pharmacy, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
- EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
| | - Haudrey Assier
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
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Bérot V, Gener G, Ingen-Housz-Oro S, Gaudin O, Paul M, Chosidow O, Wolkenstein P, Assier H. Cross-reactivity in beta-lactams after a non-immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions. J Eur Acad Dermatol Venereol 2019; 34:787-794. [PMID: 31571276 DOI: 10.1111/jdv.15986] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cross-reactivity among beta-lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. OBJECTIVES To evaluate cross-reactivity beyond BLs in patients with non-immediate cutaneous adverse drug reaction (non-immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. PATIENTS/MATERIALS/METHODS We conducted a retrospective single-centre study in consecutive patients consulting between 2010 and 2018 with an active BL-suspected non-immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P-IDR)] for at least three penicillin's subclasses and amino- and non-amino-cephalosporins (at least one aminocephalosporin). Cross-reactivity among subclasses was investigated for patients with positive tests. RESULTS We included 56 patients, among whom 46 amoxicillin-suspected were and seven cephalosporin-suspected. Twenty-nine had severe CADR, and 27 had non-immediate maculopapular exanthema (MPE). Twenty-two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin-suspected, 10 (55.6%) showed cross-reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non-aminocephalosporin. No amoxicillin- or cephalosporin-suspected patient showed cross-reactivity with aztreonam or carbapenems. P-IDR showed cross-reactivity only once. CONCLUSION After a suspected BL-induced non-immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross-reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross-reactivity was frequent and PT was sufficient to this purpose. The frequent cross-reactivity among penicillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross-allergies are rarer.
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Affiliation(s)
- V Bérot
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - G Gener
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Cutaneous Adverse Reactions, Créteil, France
| | - S Ingen-Housz-Oro
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Cutaneous Adverse Reactions, Créteil, France.,EA7379 EpidermE, UPEC, Créteil, France
| | - O Gaudin
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Cutaneous Adverse Reactions, Créteil, France
| | - M Paul
- EA7379 EpidermE, UPEC, Créteil, France.,Department of Pharmacy, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - O Chosidow
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Cutaneous Adverse Reactions, Créteil, France.,Université Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - P Wolkenstein
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Cutaneous Adverse Reactions, Créteil, France.,Université Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - H Assier
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Cutaneous Adverse Reactions, Créteil, France
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Assier H, Valeyrie-Allanore L, Gener G, Verlinde Carvalh M, Chosidow O, Wolkenstein P. Patch testing in non-immediate cutaneous adverse drug reactions: value of extemporaneous patch tests. Contact Dermatitis 2017; 77:297-302. [PMID: 28730661 DOI: 10.1111/cod.12842] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2017] [Accepted: 05/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patch testing following a standardized protocol is reliable for identifying the culprit drug in cutaneous adverse drug reactions (CADRs). However, these patch tests (PTs) require pharmaceutical material and staff, which are not always easily available. OBJECTIVES To evaluate an extemporaneous PT method in CADRs. METHODS We retrospectively analysed data for all patients referred to our department between March 2009 and June 2013 for patch testing after a non-immediate CADR. The patients who supplied their own suspected drugs were tested both with extemporaneous PTs and with conventional PTs. Extemporaneous PTs involved a nurse crushing and diluting the drug in pet. in a ratio of approximately one-third to two-thirds. Standardized PTs were performed according to guidelines, with commercial drugs diluted to 30% or with active ingredients diluted to 10%. We analysed the data for the two PT methods in terms of the number of positive test reactions, drugs tested, and type of CADR for patients in whom the two PT methods were used. RESULTS In total, 75 of 156 patients underwent the two PT procedures, including 91 double tests. Overall, 21 tests gave positive reactions with the two methods, and 69 other tests gave negative results with the two methods. CONCLUSION Our series yielded results similar to those of published series concerning the types of CADR and the drugs responsible. Our results suggest that, for CADRs, if a patient supplies a suspected drug but if the pharmaceutical material and staff are not available for conventional PTs, extemporaneous PTs performed by the nurse with the commercial drug used by the patient can be useful and reliable.
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Affiliation(s)
- Haudrey Assier
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France
| | - Laurence Valeyrie-Allanore
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France.,EA 7379 EpiDermE, UPEC, 94010, Créteil, France
| | - Gwendeline Gener
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France
| | | | - Olivier Chosidow
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France.,EA 7379 EpiDermE, UPEC, 94010, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France.,EA 7379 EpiDermE, UPEC, 94010, Créteil, France
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Lebrun-Vignes B, Valeyrie-Allanore L. Toxidermies. Rev Med Interne 2015; 36:256-70. [DOI: 10.1016/j.revmed.2014.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 07/15/2014] [Accepted: 10/08/2014] [Indexed: 12/17/2022]
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:386-9. [PMID: 21720221 DOI: 10.1097/aci.0b013e3283497dc5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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