Dermatology and Allergy department, University Hospital of Nancy, Pole des specialités medicales, Universite de Lorraine, Brabois Hospital, 6 rue du Morvan, Vandoeuvre les Nancy, 54500, France,
Curr Allergy Asthma Rep. 2014 Jun;14(6):442. doi: 10.1007/s11882-014-0442-8.
Drug skin tests can reproduce delayed hypersensitivity to drugs and entail a moderate reexposure of patients to offending drugs. Drug patch tests (DPTs) and prick tests can be done with any commercialized form of a drug. In non-severe delayed non-IgE-mediated reactions to drugs, intradermal tests (IDT) with delayed readings have a greater value, but their techniques lack standardization. A negative drug skin test does not exclude the responsibility of a drug, and the drug must be rechallenged in non-severe cases. DPTs are useful in maculopapular rashes, flexural exanthemas, and if done in situ, also in fixed drug eruption. Their best indication is in acute generalized exanthematous pustulosis or drug reaction with eosinophilia and systemic symptoms (DRESS). They should be carried out cautiously, following strict guidelines. Prick tests have a low value but they can sometimes be positive on delayed readings. In non-severe delayed reactions to drugs, intradermal tests with delayed readings are the most sensitive skin tests especially for beta-lactam antibiotics, radiocontrast media, heparins but also some biological agents. The value of patch testing varies according to the implicated drug and the non-immediate adverse drug reaction. In DRESS, DPTs have a good value in testing carbamazepine or proton pump inhibitors but remain negative in testing with allopurinol or salazopyrin. In toxic epidermal necrolysis, DPTs are safe but positive in only 9 to 23 % of the reported cases.
药物皮肤试验可重现药物迟发性超敏反应，使患者适度重新接触致病药物。药物斑贴试验（DPT）和皮内试验（IDT）可用于任何商业化的药物形式。在非严重的迟发性非 IgE 介导的药物反应中，具有延迟读数的皮内试验（IDT）具有更大的价值，但它们的技术缺乏标准化。药物皮肤试验阴性并不能排除药物的责任，在非严重情况下必须重新进行药物激发试验。DPT 适用于斑丘疹、屈侧疹，如果原位进行，也适用于固定性药物疹。其最佳适应证是急性全身性发疹性脓疱病或伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）。应遵循严格的指南谨慎进行。皮内试验价值较低，但有时在延迟读数时呈阳性。在非严重的迟发性药物反应中，具有延迟读数的皮内试验是最敏感的皮肤试验，特别是对于β-内酰胺类抗生素、放射性对比剂、肝素，但也包括一些生物制剂。斑贴试验的价值取决于涉及的药物和非即时性药物不良反应。在 DRESS 中，DPT 对卡马西平或质子泵抑制剂的检测具有良好的价值，但在检测别嘌呤醇或柳氮磺胺吡啶时仍为阴性。在中毒性表皮坏死松解症中，DPT 是安全的，但在报告的病例中仅 9%至 23%呈阳性。
