Drug Provocation Testing in Allergological Work-Up of DRESS: A Retrospective Real-Life Experience From a Specialist Centre.

IF 4.6 1区医学 Q2 ALLERGY

Contact Dermatitis Pub Date : 2025-07-31 DOI:10.1111/cod.70003

Haudrey Assier, Thomas Bettuzzi, Elio Kechichian, Reine Merhy, Margaux Fleck, Amandine Weill, Olivier Gaudin, Gwendeline Gener, Pierre Wolkenstein, Saskia Ingen-Housz-Oro

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引用次数: 0

Abstract

Background: In drug reaction with eosinophilia and systemic symptoms (DRESS), cutaneous tests help to identify the responsible drug. However, uncertainty may persist and drug provocation tests (DPTs) could enable contraindications for essential drugs to be avoided.

Objectives: To report the experience of DPTs in a series of DRESS patients managed in a referral centre for severe drug reactions.

Methods: We performed a single-centre retrospective study (October 2015-October 2021) of patients referred for an allergological work-up after DRESS.

Results: Seventy-five patients were included (49 females, mean age 55 years, 212 suspected drugs). Cutaneous tests, realised in all patients, were positive in 38, and DPTs were performed in 39 patients (65 drugs: 41 suspected and 24 alternative drugs, all with negative cutaneous tests). DPTs were performed regardless of DRESS severity or RegiSCAR score, at full dose (FD) for 40 drugs and graduated dose (from 1/100 FD) for 25 drugs. The objective was always to avoid contra-indications or to propose alternative drugs. Mild reactions occurred following challenge with 13 drugs (all suspected drugs), of which 6 could be continued. DPTs were more often positive when more drugs were suspected or reintroduced, but less often when a high-notoriety drug was suspected and avoided.

Conclusions: DPTs can be considered in DRESS by experienced teams to avoid unnecessary contraindications for essential drugs.

查看原文本刊更多论文

DRESS过敏检查中的药物激发试验：来自专家中心的回顾性现实生活经验。

背景：在嗜酸性粒细胞增多和全身症状（DRESS）的药物反应中，皮肤试验有助于确定负责的药物。然而，不确定性可能持续存在，药物激发试验（DPTs）可以避免基本药物的禁忌症。目的：报告在转诊中心处理严重药物反应的一系列DRESS患者的dpt经验。方法：我们进行了一项单中心回顾性研究（2015年10月- 2021年10月），患者接受了DRESS后的过敏检查。结果：纳入75例患者（女性49例，平均年龄55岁，212例疑似用药）。在所有患者中，38例皮肤试验呈阳性，39例患者进行了dpt（65种药物：41种疑似药物和24种替代药物，皮肤试验均为阴性）。无论DRESS严重程度或RegiSCAR评分如何，40种药物采用全剂量（FD）， 25种药物采用分级剂量（从1/100 FD开始）进行dpt。目的始终是避免禁忌症或建议替代药物。13种药物（均为疑似药物）给药后出现轻度反应，其中6种可继续给药。当怀疑有更多的药物或重新引入时，DPTs往往呈阳性，但当怀疑有一种臭名昭著的药物并避免使用时，DPTs的阳性情况较少。结论：经验丰富的团队可以在DRESS中考虑DPTs，以避免不必要的基本药物禁忌症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Contact Dermatitis 医学-过敏

CiteScore

4.60

自引率

30.90%

发文量

227

审稿时长

4-8 weeks

期刊介绍： Contact Dermatitis is designed primarily as a journal for clinicians who are interested in various aspects of environmental dermatitis. This includes both allergic and irritant (toxic) types of contact dermatitis, occupational (industrial) dermatitis and consumers" dermatitis from such products as cosmetics and toiletries. The journal aims at promoting and maintaining communication among dermatologists, industrial physicians, allergists and clinical immunologists, as well as chemists and research workers involved in industry and the production of consumer goods. Papers are invited on clinical observations, diagnosis and methods of investigation of patients, therapeutic measures, organisation and legislation relating to the control of occupational and consumers".