Barbaud A, Reichert-Penetrat S, Tréchot P, Jacquin-Petit M A, Ehlinger A, Noirez V, Faure G C, Schmutz J L, Béné M C
Department of Dermatology, Fournier Hospital, Nancy, France.
Br J Dermatol. 1998 Jul;139(1):49-58. doi: 10.1046/j.1365-2133.1998.02313.x.
Skin testing with the suspected compound has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (ADRs), but the value and specificity of these tests need to be determined. In this study, 72 patients with presumed drug eruptions (27 maculopapular, 18 urticarial, seven erythrodermic, nine eczematous, four photosensitivity, three fixed drug eruptions, three with pruritus and one with acute generalized exanthematous pustulosis) were assessed. All had drug patch tests; 46 also had prick tests and 30 had intradermal tests (performed on hospitalized patients using a sterile solution of the suspected drug, diluted sequentially) with immediate and delayed readings. Among these patients, 52 (72%) had a positive skin test reaction, 43%, 24% and 67% in patch, prick and intradermal skin tests, respectively. The results of skin tests varied with the drug tested and with the clinical type of cutaneous ADR, as a significantly higher number of positive patch tests was observed in maculopapular rashes than in urticarial reactions (P = 0.001). This study supports the value of careful sequential drug skin testing in establishing the cause of cutaneous ADR. Guidelines are proposed for performing these tests, and these include the use of appropriate negative control patients to avoid false-positive results.
据报道，对疑似化合物进行皮肤试验有助于确定皮肤药物不良反应（ADR）的病因，但这些试验的价值和特异性仍有待确定。在本研究中，对72例疑似药疹患者（27例斑丘疹型、18例荨麻疹型、7例红皮病型、9例湿疹型、4例光敏型、3例固定型药疹、3例瘙痒型和1例急性泛发性脓疱病型）进行了评估。所有患者均进行了药物斑贴试验；46例还进行了点刺试验，30例进行了皮内试验（对住院患者使用疑似药物的无菌溶液依次稀释后进行），并进行即时和延迟读数。在这些患者中，52例（72%）皮肤试验反应呈阳性，斑贴试验、点刺试验和皮内试验的阳性率分别为43%、24%和67%。皮肤试验结果因所测试的药物和皮肤ADR的临床类型而异，因为在斑丘疹皮疹中观察到的阳性斑贴试验数量明显高于荨麻疹反应（P = 0.001）。本研究支持在确定皮肤ADR病因时进行仔细的序贯药物皮肤试验的价值。本文提出了进行这些试验的指南，其中包括使用适当的阴性对照患者以避免假阳性结果。
