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.

中文翻译：

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皮肤试验在嗜酸性粒细胞增多和全身症状 (DRESS) 药物反应中的效用和安全性：系统评价

背景

确定伴有嗜酸性粒细胞增多和全身症状的药物反应 (DRESS) 中的罪魁祸首药物至关重要。已使用皮肤测试，但尚不清楚这些测试有多敏感。

客观的

确定皮肤试验在评估 DRESS 药物因果关系中的价值。

方法

对 1996 年以后在明确定义的 DRESS 病例中进行的皮肤试验（皮肤点刺试验 = SPT，斑贴试验 = PT，皮内试验 = IDT）的出版物进行了系统的文献检索。提取了测试结果、药物罪责评估和挑战测试数据。

结果

共有 17 篇文章符合纳入标准。在 290 名 DRESS 患者中，斑贴试验最为频繁（PT = 97.2% [n = 282]，IDT = 12.4% [n = 36]，SPT = 3.1% [n = 9]）。58.4%（n = 160 / 282）的 PT、66.5% 的 IDT 和 25% 的 SPT 出现阳性结果。当对药物因果关系的置信度很高时（n = 73 of 194），测试与临床怀疑的相关性不高：PTs，37.6%；IDT，36.5%。皮肤测试与刺激测试 (n = 12) 的直接比较显示 83.3% 的相关性。在 8 例 PT 阴性病例中报告了阳性 IDT 结果。

结论

皮肤测试，特别是 PT 和 IDT，已被报告为诊断 DRESS 致病药物的工具。方法、结果分析和队列报告的异质性使得无法通过荟萃分析来确定已发表文献的敏感性和特异性，并突出该领域的弱点。我们建议国际合作对于协调更大队列超敏反应测试研究的方法和报告措施至关重要。