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Yadav P, Bhatia R, Vasisht S, Sethi J. Patch test with multiple antipyretics in a case of fixed drug eruption in a child. Contact Dermatitis 2024; 90:422-423. [PMID: 38146069 DOI: 10.1111/cod.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 10/31/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Piyush Yadav
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
| | - Riti Bhatia
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
| | - Shivani Vasisht
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
| | - Jyoti Sethi
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, India
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Bavbek S, Kepil Özdemir S, Bonadonna P, Atanaskovic-Markovic M, Barbaud A, Brockow K, Laguna Martinez J, Nakonechna A, Pagani M, Arcolacı A, Lombardo C, Torres MJ. Hypersensitivity reactions to proton pump inhibitors. An EAACI position paper. Allergy 2024; 79:552-564. [PMID: 38013608 DOI: 10.1111/all.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Proton pump inhibitors (PPIs) are invaluable therapeutic options in a variety of dyspeptic diseases. In addition to their well-known risk profile, PPI consumption is related to food and environmental allergies, dysbiosis, osteoporosis, as well as immediate and delayed hypersensitivity reactions (HSRs). The latter, although a rare event, around 1%-3%, due to the extraordinarily high rate of prescription and consumption of PPIs are related to a substantial risk. In this Position Paper, we provide clinicians with practical evidence-based recommendations for the diagnosis and management of HSRs to PPIs. Furthermore, the unmet needs proposed in the document aim to stimulate more in-depth investigations in the topic.
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Affiliation(s)
- Sevim Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Seçil Kepil Özdemir
- Department of Chest Diseases, Allergy and Immunology Unit, İzmir Faculty of Medicine, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | | | - Marina Atanaskovic-Markovic
- Department of Allergology and Pulmonology, Faculty of Medicine, University of Belgrade, University Children's Hospital, Belgrade, Serbia
| | - Annick Barbaud
- Département de dermatologie et allergologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Jose Laguna Martinez
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain
| | - Alla Nakonechna
- Allergy and Clinical Immunology Department, University of Liverpool, Royal Preston Hospital, Lancashire Teaching Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Mauro Pagani
- Medicine Department, Medicine Ward Mantova Hospital, ASST di Mantova, Mantova, Italy
| | | | - Carla Lombardo
- Division of Dermatology and Allergy, APSS - Trento Hospital, Trento, Italy
| | - Maria J Torres
- Allergy Unit, Regional University Hospital of Malaga, IBIMA-UMA-ARADyAL, Malaga, Spain
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Traineau H, Milpied B, Soria A, Assier H, Tetart F, Bernier C, Le Bouëdec MCF, Gener G, Kurihara F, Bauvin O, Delauney J, Amsler E, Bara C, Pelletier F, Valois A, Castelain F, de Risi Pugliese T, Hamelin A, Barbaud A. In Situ Patch Test and Repeated Open Application Test for Fixed Drug Eruption: A Multicenter Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:460-468. [PMID: 37863314 DOI: 10.1016/j.jaip.2023.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Few studies have evaluated allergy workup in fixed drug eruption (FDE) in a large population. OBJECTIVE To evaluate the sensitivity of a standardized allergy workup for diagnosing the cause of FDE, with a focus on in situ repeated open application tests (ROATs). METHODS In a retrospective multicenter study, we analyzed the practice of conducting a complete allergy workup for the etiological diagnosis of FDE. It consisted of 3 steps: in situ patch tests (PTs) for all cases except pure mucosal involvement, followed by in situ ROAT if in situ PT results were negative, and finally a drug challenge (DC). The in situ ROAT involved daily application of the suspected drug on a previously affected FDE site for 7 days. RESULTS Of 98 suspected FDE cases, 61 patients (median age 61 y; male-to-female ratio 1.8) with a complete allergy workup were included. In 4 cases, even the DC yielded negative results. Among the remaining 57 patients with a positive workup, implicated drugs included paracetamol (12 cases), β-lactams (11 cases), imidazoles (9 cases, including 5 with metronidazole), nonsteroidal anti-inflammatory drugs (8 cases), iodinated contrast media (4 cases), cotrimoxazole (3 cases), and various other drugs in 10 patients. The diagnosis was confirmed by in situ PT in 17 of 54 cases (31.5%), in situ ROAT in 14 of 40 cases (35%) (with 4 cases showing remote reactivation of FDE sites), and DC in 26 cases. CONCLUSIONS The sequential allergy workup involving successively in situ PT, in situ ROAT, and DC is a reliable and safe method for diagnosing the cause of FDE. In situ tests exhibited a sensitivity of over 50%.
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Affiliation(s)
- Hélène Traineau
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brigitte Milpied
- Centre hospitalo-universitaire (CHU) de Bordeaux, Dermatology department, Saint André hospital, Bordeaux, France
| | - Angèle Soria
- Cimi-Paris Inserm 1135, AP-HP, Sorbonne University, Hôpital Tenon, Dermatology and allergology department, Paris, France
| | - Haudrey Assier
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | | | | | | | - Gwendeline Gener
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | - Flore Kurihara
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Juliette Delauney
- CHU d'Angers, Dermatology department, Centre hospitalier de Cholet, Angers, France
| | - Emmanuelle Amsler
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Corina Bara
- Dermatology department, Centre hospitalier du Mans, Le Mans, France
| | | | - Aude Valois
- Dermatology department, Hôpital d'instruction des armées Sainte Anne, Toulon, France
| | | | - Tullia de Risi Pugliese
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Aurore Hamelin
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Annick Barbaud
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
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Xu F, Zhang H, Xiao H, Meng J. Delayed-type allergic reaction to furazolidone: A case report and review of the literature. Contact Dermatitis 2023; 89:496-500. [PMID: 37750438 DOI: 10.1111/cod.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Furazolidone is a nitrofuran antimicrobial agent used in the treatment of bacterial and protozoal infections. Hypersensitivity to furazolidone is rarely reported and only eight cases have been documented in English since 1967. OBJECTIVES To report a 24-year-old man who developed exanthematous drug eruptions in general and swelling sensation of the hands after first dose of oral administration of medicines for Helicobacter pylori infection 7 h later, who was finally confirmed with delayed-type IV allergic reaction to furazolidone by provocation tests. And to review the existing literature. METHODS Thorough clinical examination, prick, intradermal, and patch tests, drug provocation tests were performed in the patient. RESULTS Skin tests of all used drugs were negative. Drug provocation tests to furazolidone resulted to be positive. CONCLUSIONS Clinicians should be aware that furazolidone may induce delayed-type allergic reactions; diagnostic approaches should be taken to identify the responsible drug when multiple medications were used concurrently.
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Affiliation(s)
- Feng Xu
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
| | - Hongting Zhang
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
| | - Hao Xiao
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
| | - Juan Meng
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
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Teo YX, Friedmann PS, Polak ME, Ardern-Jones MR. Utility and Safety of Skin Tests in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:481-491.e5. [PMID: 36154897 DOI: 10.1016/j.jaip.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 08/10/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Ying Xin Teo
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Peter Simon Friedmann
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Marta Ewa Polak
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Roger Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom.
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Roux C, Ben Said B, Milpied B, Bernier C, Staumont-Sallé D, Dezoteux F, Soria A, Barbaud A, Valeyrie-Allanore L, Tétart F, Bellon N, Lebrun-Vignes B, Gener G, Paul M, Ingen-Housz-Oro S, Assier H. Skin Testing and Drug Provocation Tests in Epidermal Necrolysis: A French Experience. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3252-3261.e2. [PMID: 35870724 DOI: 10.1016/j.jaip.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are limited data on the use of skin testing, other than patch testing, and challenges in the evaluation of epidermal necrolysis (EN), including Stevens-Johnson syndrome and toxic epidermal necrolysis. OBJECTIVE To report a French multicenter experience in skin testing and challenges in EN, and investigate the factors associated with tests' positivity. METHODS All patients who were evaluated by patch tests (PTs), skin prick tests, intradermal tests (IDTs), or drug provocation tests (DPTs) for EN between 2010 and 2020 were retrospectively included through 2 French drug reaction networks. RESULTS In total, 113 patients were included from 8 centers. Median (interquartile range) time from EN to hypersensitivity workup was 7.9 months (5.1-15 months). All patients had PTs, 17 (15%) had skin prick tests or IDTs with delayed readings and 32 (28.3%) had DPTs. One mild reaction occurred after a DPT. Overall, 22 patients (19.5%) had positive PTs, and the only factors associated with positivity were Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN) score and drug class. Only 1 IDT was positive but considered irrelevant. The DPTs were never performed to prove responsibility of a highly suspected drug but were used to confirm current tolerance of needed medications. CONCLUSIONS Allergological workup in EN, performed by specialists involved in EN, seems safe. Skin tests, although of limited sensitivity, can be helpful for considering the reintroduction of essential drugs according to a benefit-to-risk decision. We propose an algorithm for approaching hypersensitivity testing in patients with EN, to be adapted to each patient.
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Affiliation(s)
- Camille Roux
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Benoit Ben Said
- Department of Allergy and Clinical Immunology, Edouard Herriot Hospital, HCL, Claude Bernard Lyon 1 University, Lyon, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France
| | - Brigitte Milpied
- Department of Allergy and Clinical Immunology, Edouard Herriot Hospital, HCL, Claude Bernard Lyon 1 University, Lyon, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; Department of Dermatology, National Reference Center for Rare Skin Diseases, University of Bordeaux, Bordeaux, France
| | - Claire Bernier
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Nantes University Hospital, Nantes, France
| | - Delphine Staumont-Sallé
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Lille University Hospital, Lille, France
| | - Frédéric Dezoteux
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Lille University Hospital, Lille, France
| | - Angèle Soria
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology and Allergy, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Annick Barbaud
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology and Allergy, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Laurence Valeyrie-Allanore
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Private Practice, Saint-Mandé, France
| | - Florence Tétart
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Rouen University Hospital, Normandie University, Rouen, France
| | - Nathalia Bellon
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Necker Hospital, AP-HP, Paris, France
| | - Bénédicte Lebrun-Vignes
- French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Pharmacology, Pharmacovigilance Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France; Paris Est Créteil University, EpiDermE, Créteil, France
| | - Gwendeline Gener
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Muriel Paul
- Department of Hospital Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Paris Est Créteil University, EpiDermE, Créteil, France
| | - Haudrey Assier
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France; Department of Allergy and Clinical Immunology, Edouard Herriot Hospital, HCL, Claude Bernard Lyon 1 University, Lyon, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France.
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de Groot AC. Patch testing in Drug reaction with eosinophilia and systemic symptoms (DRESS): a literature review. Contact Dermatitis 2022; 86:443-479. [PMID: 35233782 DOI: 10.1111/cod.14090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. 105 drugs were identified that have together caused 536 positive patch tests in 437 patients suffering from DRESS. By far most reactions (n=145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions are anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%) and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin) and possibly iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS, but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is (far) higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anton C de Groot
- dermatologist np Schipslootweg 5, 8351, HV, Wapserveen, The Netherlands
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Barbaud A, Romano A. Skin Testing Approaches for Immediate and Delayed Hypersensitivity Reactions. Immunol Allergy Clin North Am 2022; 42:307-322. [DOI: 10.1016/j.iac.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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9
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Barbaud A, Castagna J, Soria A. Skin Tests in The Work-Up of Cutaneous Adverse Drug Reactions: A Review and Update. Contact Dermatitis 2022; 86:344-356. [PMID: 35122269 DOI: 10.1111/cod.14063] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Julie Castagna
- AP-HP, Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Angèle Soria
- Sorbonne Université, INSERM 1135 Cimi-Paris, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Département de dermatologie et d'allergologie, 4 rue de la Chine, Paris
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10
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Patch Testing in Drug Eruptions: Practical Aspects and Literature Review of Eruptions and Culprit Drugs. Dermatitis 2022; 33:16-30. [PMID: 35029348 DOI: 10.1097/der.0000000000000839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT There is overwhelming evidence that many delayed cutaneous adverse drug reactions (beginning >6 hours after drug intake) are mediated by delayed-type (type IV) hypersensitivity, including maculopapular eruptions, erythroderma, symmetrical drug-related intertriginous and flexural exanthema/baboon syndrome, eczematous eruptions, fixed drug eruptions, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome. Therefore, after resolution of the reaction, patch tests should be performed as first diagnostic method to identify the culprit drug(s). This article provides tools to perform drug patch tests properly and safely, discussing clinical history, indications, procedure, drug patch test materials, sensitivity, the meaning of negative patch tests, and safety of the procedure. In addition, a literature review of eruptions and culprit drugs is provided in tabular format.
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Blanca-Lopez N, Atanaskovic-Markovic M, Gomes ER, Kidon M, Kuyucu S, Mori F, Soyer O, Caubet JC. An EAACI Task Force report on allergy to beta-lactams in children: Clinical entities and diagnostic procedures. Pediatr Allergy Immunol 2021; 32:1426-1436. [PMID: 33931922 DOI: 10.1111/pai.13529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/24/2021] [Indexed: 12/14/2022]
Abstract
Beta-lactam (BL) allergy suspicion is common in children and constitutes a major public health problem, with an impact on patient's health and on medical costs. However, it has been found that most of these reactions are not confirmed by a complete allergic workup. The diagnostic value of the currently available allergy tests has been investigated intensively recently by different groups throughout the world. This has led to major changes in the management of children with a suspected BL allergy. Particularly, it is now well accepted that skin tests can be skipped before the drug provocation test in children with a benign non-immediate reaction to BL. However, there is still a debate on the optimal allergic workup to perform in children with a benign immediate reaction. In addition, management of children with severe cutaneous adverse drug reactions remains difficult. In this review, based on a selection of the most relevant studies found in the literature, we will review and discuss the diagnosis of different forms of BL allergy in children.
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Affiliation(s)
| | | | - Eva R Gomes
- Allergy Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mona Kidon
- Safra Children's Hospital and the Clinical Immunology, Angioedema and Allergy Unit, Chaim Sheba Medical Center, Tel Hashomer, Faculty of Pediatric Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Semanur Kuyucu
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Francesca Mori
- Allergy Unit, Department of Pediatric, Meyer Children's Hospital, Florence, Italy
| | - Ozge Soyer
- Department of Pediatric Allergy, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, Geneva University Hospital, Geneva, Switzerland
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Vissing MB, Bhasin A, Sluzevich J. The role and histopathology of oral drug challenge in the evaluation of fixed drug eruptions. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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13
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Patch Testing in Adverse Drug Reactions. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bergmann MM, Caubet JC. Role of in vivo and in vitro Tests in the Diagnosis of Severe Cutaneous Adverse Reactions (SCAR) to Drug. Curr Pharm Des 2020; 25:3872-3880. [PMID: 31696801 DOI: 10.2174/1381612825666191107104126] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022]
Abstract
Severe cutaneous adverse reactions (SCAR) are life-threatening conditions including acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Diagnosis of causative underlying drug hypersensitivity (DH) is mandatory due to the high morbidity and mortality upon re-exposure with the incriminated drug. If an underlying DH is suspected, in vivo test, including patch tests (PTs), delayed-reading intradermal tests (IDTs) and in vitro tests can be performed in selected patients for which the suspected culprit drug is mandatory, or in order to find a safe alternative treatment. Positivity of in vivo and in vitro tests in SCAR to drug varies depending on the type of reaction and the incriminated drugs. Due to the severe nature of these reactions, drug provocation test (DPT) is highly contraindicated in patients who experienced SCAR. Thus, sensitivity is based on positive test results in patients with a suggestive clinical history. Patch tests still remain the first-line diagnostic tests in the majority of patients with SCAR, followed, in case of negative results, by delayed-reading IDTs, with the exception of patients with bullous diseases where IDTs are still contra-indicated. In vitro tests have shown promising results in the diagnosis of SCAR to drug. Positivity is particularly high when the lymphocyte transformation test (LTT) is combined with cytokines and cytotoxic markers measurement (cyto-LTT), but this still has to be confirmed with larger studies. Due to the rarity of SCAR, large multi-center collaborative studies are needed to better study the sensitivity and specificity of in vivo and in vitro tests.
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Affiliation(s)
- Marcel M Bergmann
- Pediatric Allergology Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.,Centro Pediatrico del Mendrisiotto, Mendrisio, Switzerland
| | - Jean-Christoph Caubet
- Pediatric Allergology Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
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Romano A, Atanaskovic‐Markovic M, Barbaud A, Bircher AJ, Brockow K, Caubet J, Celik G, Cernadas J, Chiriac A, Demoly P, Garvey LH, Mayorga C, Nakonechna A, Whitaker P, Torres MJ. Towards a more precise diagnosis of hypersensitivity to beta-lactams - an EAACI position paper. Allergy 2020; 75:1300-1315. [PMID: 31749148 DOI: 10.1111/all.14122] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023]
Abstract
A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with beta-lactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost-effective, as possible. For this purpose, a bibliographic search on large studies regarding BL hypersensitivity diagnosis was performed by an EAACI task force, which reviewed and evaluated the literature data using the GRADE system for quality of evidence and strength of recommendation. The updated guidelines provide a risk stratification in BL hypersensitivity according to index reaction(s), as well as an algorithmic approach, based on cross-reactivity studies, in patients with a suspicion of BL hypersensitivity and an immediate need for antibiotic therapy, when referral to an allergist is not feasible. Furthermore, the update addresses availability and concentrations of skin test (ST) reagents, ST and drug provocation test (DPT) protocols, and diagnostic algorithms and administration of alternative BL in allergic subjects. Specifically, distinct diagnostic algorithms are suggested depending on risk stratification of the patient into high and low risk based on the morphology and chronology of the reaction, immediate (ie, occurring within 1-6 hours after the last administered dose) or nonimmediate (ie, occurring more than 1 hour after the initial drug administration), and the reaction severity. Regarding the allergy workup, the main novelty of this document is the fact that in some low-risk nonimmediate reactions ST are not mandatory, especially in children. For DPT, further studies are necessary to provide data supporting the standardization of protocols, especially of those regarding nonimmediate reactions, for which there is currently no consensus.
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Affiliation(s)
- Antonino Romano
- Casa di Cura Quisisana Rome & Fondazione Mediterranea G.B. Catania Italy
| | | | - Annick Barbaud
- Departement of Dermatology and Allergology Institut Pierre Louis d'Epidemiologie et de Sante Publique INSERM Tenon Hospital Sorbonne Université Paris France
| | | | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Technische Universität München Munich Germany
| | | | - Gulfem Celik
- Department of Immunology and Allergy Ankara University School of Medicine Ankara Turkey
| | - Josefina Cernadas
- Department of Allergy and Immunology Centro Hospitalar Universitário de S João Porto Portugal
| | - Anca‐Mirela Chiriac
- Division of Allergy Department of Pulmonology Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
- UMRS 1136 Equipe ‐ EPAR ‐ IPLESP UPMC Univ Sorbonne Universités Paris France
| | - Pascal Demoly
- Division of Allergy Department of Pulmonology Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
- UMRS 1136 Equipe ‐ EPAR ‐ IPLESP UPMC Univ Sorbonne Universités Paris France
| | - Lene H. Garvey
- Allergy Clinic Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Cristobalina Mayorga
- Allergy Research Group Instituto de Investigación Biomédica de Málaga-IBIMA Malaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga-UMA-ARADyAL Malaga Spain
| | - Alla Nakonechna
- Clinical Immunology and Allergy Unit Sheffield Teaching Hospital Sheffield UK
- University of Liverpool Liverpool UK
| | - Paul Whitaker
- Regional Adult Cystic Fibrosis Unit St James's Hospital Leeds UK
| | - María José Torres
- Allergy Unit Hospital Regional Universitario de Málaga-UMA-ARADyAL Malaga Spain
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Fowler T, Bansal AS, Lozsádi D. Risks and management of antiepileptic drug induced skin reactions in the adult out-patient setting. Seizure 2019; 72:61-70. [DOI: 10.1016/j.seizure.2019.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022] Open
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18
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Making a diagnosis in severe cutaneous drug hypersensitivity reactions. Curr Opin Allergy Clin Immunol 2019; 19:283-293. [DOI: 10.1097/aci.0000000000000546] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Stingeni L, Bianchi L, Hansel K, Corazza M, Gallo R, Guarneri F, Patruno C, Rigano L, Romita P, Pigatto PD, Calzavara-Pinton P. Italian Guidelines in Patch Testing - adapted from the European Society of Contact Dermatitis (ESCD). GIORN ITAL DERMAT V 2019; 154:227-253. [DOI: 10.23736/s0392-0488.19.06301-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ingen-Housz-Oro S, Assier H, Gener G, Milpied B, Soria A, Bernier C, Descamps V, Tetart F, Staumont-Sallé D, Valeyrie-Allanore L, Valois A, Sassolas B, Bensaid B, Lebrun-Vignes B, Barbaud A. [Delayed hypersensitivity to anti-tuberculosis drugs. Proposed practical management plan for exanthema: when to stop, which allergological investigations to perform, and how to restart treatment]. Ann Dermatol Venereol 2019; 146:313-318. [PMID: 30904277 DOI: 10.1016/j.annder.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/06/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022]
Affiliation(s)
- S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France.
| | - H Assier
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - G Gener
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Milpied
- Service de dermatologie, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - A Soria
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - C Bernier
- Service de dermatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - V Descamps
- Service de dermatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - F Tetart
- Service de dermatologie, CHU Charles-Nicolle, 1, rue De Germont, 76100 Rouen, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - D Staumont-Sallé
- Service de dermatologie, CHRU Claude-Huriez, rue Michel-Polonovski, 59000 Lille, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - L Valeyrie-Allanore
- Cabinet de dermatologie, 18, avenue Quihou, 94160 Saint-Mandé, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - A Valois
- Service de dermatologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Sassolas
- Service de médecine interne, hôpital Cavale-Blanche, CHRU de Brest, boulevard Tanguy Prigent, 29600 Brest, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Bensaid
- Service de dermatologie, hôpital Edouard-Herriot, 5, place D'Arsonval, 69003 Lyon, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - B Lebrun-Vignes
- Département de pharmacovigilance, hôpital La Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - A Barbaud
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | -
- Groupe FISARD (groupe Toxidermies) de la Société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
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Usefulness of Cutaneous Provocation Tests to Study Drugs Responsible for Cutaneous Adverse Drug Reactions. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0198-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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22
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Phillips EJ, Bigliardi P, Bircher AJ, Broyles A, Chang YS, Chung WH, Lehloenya R, Mockenhaupt M, Peter J, Pirmohamed M, Roujeau JC, Shear NH, Tanno LK, Trubiano J, Valluzzi R, Barbaud A. Controversies in drug allergy: Testing for delayed reactions. J Allergy Clin Immunol 2019; 143:66-73. [PMID: 30573342 PMCID: PMC6429556 DOI: 10.1016/j.jaci.2018.10.030] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 01/11/2023]
Abstract
Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.
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Affiliation(s)
- Elizabeth J Phillips
- Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch, Australia.
| | - Paul Bigliardi
- Department of Dermatology, Dermato-Allergy Division, University of Minnesota, Minneapolis, Minn
| | - Andreas J Bircher
- Department of Dermatology, Allergy Unit, University Hospital, University of Basel, Basel, Switzerland
| | - Ana Broyles
- Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan
| | - Rannakoe Lehloenya
- Division of Dermatology and Combined Drug Allergy Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Maja Mockenhaupt
- Department of Dermatology, Dokumentationszentrum schwerer Hautreaktionen (dZh), Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jonny Peter
- Division of Dermatology and Combined Drug Allergy Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | | | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, and Sorbonne Université, INSERM, Paris, France; Hospital Sírio Libanês, São Paulo, Brazil
| | - Jason Trubiano
- Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Health, University of Melbourne, Heidelberg, Australia; National Centre for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Rocco Valluzzi
- Allergy Department, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Annick Barbaud
- Dermatology and Allergy Department, Tenon Hospital, Medecine Sorbonne University, Paris, France; Assistance publique-hopitaux de Paris, Paris, France
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23
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Barbaud A. Investigations allergologiques dans les érythèmes pigmentés fixes. Méthode recommandée par le groupe FISARD de la SFD. Ann Dermatol Venereol 2018; 145:210-213. [DOI: 10.1016/j.annder.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/04/2018] [Indexed: 12/01/2022]
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Doña I, Moreno E, Pérez-Sánchez N, Andreu I, Hernández Fernandez de Rojas D, Torres MJ. Update on Quinolone Allergy. Curr Allergy Asthma Rep 2018; 17:56. [PMID: 28752367 DOI: 10.1007/s11882-017-0725-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Quinolones are a group of synthetic antibiotics widely use as first-line treatment for many infections. There has been an increase in the incidence of hypersensitivity reactions to quinolones in recent years, likely due to increased prescription. The purpose of this review is to summarize the clinical pictures, the methods used for diagnosing and the management of allergic reactions to quinolones. RECENT FINDINGS Allergic reactions to quinolones can be immediate or delayed, being anaphylaxis and maculopapular exanthema respectively the most frequent clinical entities. A precise diagnosis is particularly difficult since clinical history is often unreliable, skin tests can induce false-positive results, and commercial in vitro test are not well validated. Therefore, drug provocation testing is considered the gold standard to establish diagnosis, which is not a risk-free procedure. Cross-reactivity between quinolones is difficult to predict due to the small number of patients included in the few published studies. Moreover, hypersensitivity to quinolones has also been associated with beta-lactam and neuromuscular blocking agent allergies, although further studies are needed to understand the underlying mechanisms. Avoidance of the culprit quinolone is indicated in patients with a diagnosis of hypersensitivity to these drugs. When quinolone treatment is the only therapeutic option available, desensitization is necessary. This review summarizes the complex diagnostic approach and management of allergic reactions to quinolones.
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Affiliation(s)
- Inmaculada Doña
- Allergy Unit, Pabellón 6, primera planta, IBIMA Regional University Hospital of Malaga-UMA (Pavillion C, Hospital Civil), Plaza del Hospital Civil, 29009, Malaga, Spain.
| | - Esther Moreno
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Natalia Pérez-Sánchez
- Allergy Unit, Pabellón 6, primera planta, IBIMA Regional University Hospital of Malaga-UMA (Pavillion C, Hospital Civil), Plaza del Hospital Civil, 29009, Malaga, Spain
| | - Inmaculada Andreu
- Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica de València, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | | | - María José Torres
- Allergy Unit, Pabellón 6, primera planta, IBIMA Regional University Hospital of Malaga-UMA (Pavillion C, Hospital Civil), Plaza del Hospital Civil, 29009, Malaga, Spain
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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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Romano A, Valluzzi RL, Caruso C, Maggioletti M, Gaeta F. Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis. Curr Allergy Asthma Rep 2017; 17:23. [PMID: 28382604 DOI: 10.1007/s11882-017-0691-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-immediate cutaneous reactions (i.e., occurring at least 1 h after the initial drug administration), particularly maculopapular exanthemas and urticarial eruptions, are common during beta-lactam treatments. A T cell-mediated pathogenic mechanism has been demonstrated in some cutaneous reactions, such as maculopapular exanthema, fixed drug eruption, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome. In the diagnostic work-up, patch testing is useful, together with delayed-reading intradermal testing. Patch tests are a simple and safe diagnostic tool, which in the case of severe reactions should be used as the first line of investigation. However, patch tests are less sensitive than intradermal tests, which are preferable in subjects with mild reactions. Lymphocyte transformation or activation tests and enzyme-linked immunosorbent spot assays can be used as complementary tests. In selected cases of mild or moderate reactions, displaying negative results in the aforesaid allergy tests, a graded challenge with the implicated beta-lactam can be performed.
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Affiliation(s)
- Antonino Romano
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy. .,IRCCS Oasi Maria S.S, Troina, Italy.
| | - Rocco Luigi Valluzzi
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy.,Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Cristiano Caruso
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy
| | | | - Francesco Gaeta
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy
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Yang MS, Ban GY, Kim MH, Lim KH, Kwon HS, Song WJ, Jung JW, Lee J, Suh DI, Kwon JW, Kim SH, Shin YS, Kang HR, Kim TB, Lee BJ, Lee AY, Park HS, Cho SH. KAAACI Standardization Committee Report on the procedures and applications of the diagnostic tests for drug allergy. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.5.239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min-Suk Yang
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung-Hwan Lim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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28
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Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, Khan N, Pirmohamed M, Clark AT, Nasser SM. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy 2015; 45:300-27. [PMID: 25623506 DOI: 10.1111/cea.12468] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 10/29/2014] [Accepted: 11/07/2014] [Indexed: 12/15/2022]
Abstract
The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.
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Affiliation(s)
- R Mirakian
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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29
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Schrijvers R, Gilissen L, Chiriac AM, Demoly P. Pathogenesis and diagnosis of delayed-type drug hypersensitivity reactions, from bedside to bench and back. Clin Transl Allergy 2015; 5:31. [PMID: 26339470 PMCID: PMC4558726 DOI: 10.1186/s13601-015-0073-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/29/2015] [Indexed: 01/11/2023] Open
Abstract
Drug hypersensitivity reactions (DHR) have been present since the advent of drugs. In particular T-cell mediated delayed-type hypersensitivity reactions represent a heterogeneous clinical entity with a diverse pathogenesis and result in a considerable burden of morbidity and mortality not only driven by the reactions themselves but also by the use of alternatives which are sometimes less effective or even more dangerous. Diagnostic procedures rely on clinical history, skin testing and potential provocation testing, whereas validated in vitro diagnostic procedures are still lacking for most of them. Recent work in the field of pharmacogenomics combined with basic scientific research has provided insights in the pathogenesis of abacavir and carbamazepine hypersensitivities linked with certain human leucocyte antigen risk alleles. Nevertheless, important scientific questions on how other DHR arise and how host-drug interactions occur, remain unanswered. Recent work indicates an intricate relation between host, drug and pathogens in severe cutaneous and systemic reactions and provides more insights in the role of regulatory T-cells and viral reactivation in these reactions. In this review we focus on type IV delayed-type DHR, and address recent advances in the pathogenesis, pharmacogenomics, and diagnosis of these reactions with an emphasis on the understandings arising from basic research.
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Affiliation(s)
- Rik Schrijvers
- Laboratory of Clinical Immunology, KU Leuven, Leuven, Belgium ; Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth Gilissen
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Anca Mirela Chiriac
- Exploration des Allergies, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Paris, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - Pascal Demoly
- Exploration des Allergies, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Paris, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
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30
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Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher A, Bruze M, Cannavó A, Giménez-Arnau A, Gonçalo M, Goossens A, John SM, Lidén C, Lindberg M, Mahler V, Matura M, Rustemeyer T, Serup J, Spiewak R, Thyssen JP, Vigan M, White IR, Wilkinson M, Uter W. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis 2015; 73:195-221. [PMID: 26179009 DOI: 10.1111/cod.12432] [Citation(s) in RCA: 915] [Impact Index Per Article: 101.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
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Affiliation(s)
- Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Kristiina Aalto-Korte
- Occupational Medicine, Finnish Institute of Occupational Health, 00250 Helsinki, Finland
| | - Tove Agner
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
| | - Klaus E Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark
| | - Andreas Bircher
- Allergy Unit, Department of Dermatology, University Hospital and University of Basel, 4031 Basel, Switzerland
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, SE-20502 Malmö, Sweden
| | - Alicia Cannavó
- Hospital Municipal de Vicente López 'Profesor Bernard Houssay', Buenos Aires, Argentina
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, 08003 Barcelona, Spain
| | - Margarida Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital K. U. Leuven, B-3000 Leuven, Belgium
| | - Swen M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, D-49069 Osnabrueck, Germany
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Magnus Lindberg
- Department of Dermatology, University Hospital Örebro, SE-70185 Örebro, Sweden
| | - Vera Mahler
- Allergy Unit, Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mihály Matura
- Unit of Occupational and Environmental Dermatology, Centre for Occupational and Environmental Medicine, SLSO, SE-11365 Stockholm, Sweden
| | - Thomas Rustemeyer
- Department of Dermatology, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Jørgen Serup
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Jacob P Thyssen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Martine Vigan
- Department of Dermatology, CHRU Besançon, 25030 Besançon Cedex, France
| | - Ian R White
- Department of Cutaneous Allergy, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, UK
| | | | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany
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