Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.
Contact Dermatitis. 2010 Jan;62(1):47-53. doi: 10.1111/j.1600-0536.2009.01659.x.
In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients.
The aim of the present study is to evaluate the safety and usefulness of patch testing in DRESS.
PATIENTS/METHODS: Between January 1998 and December 2008, we studied 56 patients with DRESS induced by antiepileptic agents in 33 patients (59%), allopurinol in 19 (34%) and sulfasalazine, cotrimoxazole, tenoxicam, and amoxicillin in 1 patient each (7%).
A positive patch test reaction was observed in 18 patients (32.1%), of which 17 were with antiepileptics and 1 with tenoxicam. In the antiepileptic group, carbamazepine alone was responsible for 13 of 17 positive reactions (76.5%). Patch tests with allopurinol and its metabolite were negative in all cases attributed to this drug.
In this study, patch testing was a safe and useful method in confirming the culprit drug in DRESS induced by antiepileptic drugs, whereas it had no value in DRESS induced by allopurinol. The pathogenesis of DRESS is not yet entirely clarified, but positive patch tests suggest a drug-dependent delayed hypersensitivity mechanism.
在某些皮肤不良反应模式中，并且取决于致病药物，斑贴试验有助于确认其病因。在大样本的药物反应伴嗜酸粒细胞增多和全身症状（DRESS）患者中，尚未确定其在斑贴试验中的价值。
本研究旨在评估斑贴试验在 DRESS 中的安全性和有用性。
患者/方法：1998 年 1 月至 2008 年 12 月期间，我们研究了 33 例（59%）由抗癫痫药、别嘌醇（allopurinol）19 例（34%）、柳氮磺胺吡啶、复方磺胺甲噁唑、替诺昔康和阿莫西林各 1 例（7%）引起的 DRESS 患者 56 例。
18 例患者（32.1%）出现阳性斑贴试验反应，其中 17 例与抗癫痫药有关，1 例与替诺昔康有关。在抗癫痫药组中，卡马西平单独引起 17 例阳性反应中的 13 例（76.5%）。所有归因于别嘌醇的病例其斑贴试验均为别嘌醇及其代谢物阴性。
在这项研究中，斑贴试验是一种安全且有用的方法，可用于确认由抗癫痫药引起的 DRESS 中的致病药物，而对于由别嘌醇引起的 DRESS 则没有价值。DRESS 的发病机制尚未完全阐明，但阳性斑贴试验提示存在药物依赖性迟发型超敏反应机制。
