Utility of drug provocation tests in the evaluation of quinolone hypersensitivity reactions

Abstract Purpose of the review Iodinated radio contrast media (RCM) belong to the most common elicitors of drug hypersensitivity reactions (HR). Urticaria or anaphylaxis may occur ≤ 1(−6) hour(s) (immediate HR) and exanthems (non-immediate HR) develop > 6 h after application of RCM. Evidence for an immunologic mechanism of RCM HR against the different RCM benzene ring molecules and the benefit of allergological testing in patients with previous hypersensitivity reactions is progressively increasing. Recent findings Positive skin tests can confirm allergy in patients with previous reactions to RCM and help to select alternative better tolerated RCMs. Severe hypersensitivity reactions are mainly caused by an allergic mechanism, whereas the majority of non-severe reactions appear to be non-allergic. Skin testing is highly recommended to help identify allergic hypersensitivity reactions and to select alternatives. Using structurally different RCM is more effective than premedication for the prevention of future reactions. Drug provocation tests to RCM have been increasingly used, but are not yet standardized among different centers. Summary In patients with previous severe hypersensitivity reactions to RCM, skin testing is recommended. For future RCM-enhanced examinations in patients with previous reactions, structurally different, skin test-negative preparations should be applied. Drug provocation tests do confirm or exclude RCM hypersensitivity or may demonstrate tolerability of alternative RCMs.

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Heart Rate Variability Signal Precedes Clinical Symptoms in Hypersensitivity Reactions during Drug Provocation Tests

Biomedical Journal of Scientific & Technical Research ◽

10.26717/bjstr.2020.28.004723 ◽

2020 ◽

Vol 28 (5) ◽

Author(s):

Arantza Vega Castro

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Clinical Symptoms ◽

Hypersensitivity Reactions ◽

Provocation Tests ◽

Drug Provocation Tests

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Drug Provocation Tests in the Diagnosis of Hypersensitivity Reactions to Non-Steroidal Anti-Inflamatory Drugs in Children

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2012.12.1264 ◽

2013 ◽

Vol 131 (2) ◽

pp. AB168

Author(s):

Maria Angeles Zambonino ◽

María José Torres ◽

Candelaria Muñoz ◽

Gloria Requena ◽

Cristobalina Mayorga ◽

...

Keyword(s):

Hypersensitivity Reactions ◽

Provocation Tests ◽

Drug Provocation Tests

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Ipersensibilità ai FANS: intolleranza o allergia?

Medico e Bambino ◽

10.53126/meb40037 ◽

2021 ◽

Vol 40 (1) ◽

pp. 37-43

Author(s):

Laura Levantino ◽

Cristiana Corrado ◽

Laura Badina ◽

Sara Lega ◽

Egidio Barbi

Keyword(s):

Drug Hypersensitivity ◽

Clinical Manifestations ◽

Hypersensitivity Reactions ◽

Provocation Tests ◽

Immunological Mechanisms ◽

Drug Hypersensitivity Reactions ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Drug Provocation Tests ◽

Cox 1

Non-steroidal anti-inflammatory drugs (NSAIDs) are the main triggers of drug hypersensitivity reactions in children. According to the EAACI latest classification NSAIDs hypersensitivity reactions are differentiated into cross-reactive reactions, with non-immunological mechanisms (based on COX-1 inhibition), and selective reactions, with immunological mechanisms. Paediatric clinical manifestations of NSAID hypersensitivity are typically cutaneous, but sometimes, similarly to anaphylaxis, can involve other systems, especially the respiratory one. Differentiating between NSAID intolerance and NSAID allergy through drug provocation tests is crucial for the patient because the two clinical entities require different management.

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