title: Drug provocation tests in hypersensitivity drug reactions.
abstract: OBJECTIVE
  Drug provocation test (DPT) is necessary to diagnose most drug hypersensitivity reactions (HSRs) due to decreased sensitivity of skin testing even when combined with in-vitro tests in immunonologic drug HSR and limited availability of these tests in nonimmunologic reaction. We review the principles and controversial issues of DPT, and recent studies using DPT as a diagnostic tool.
  
  
  RESULTS
  DPT is recommended in the diagnosis of HSR to β-lactams, as well as other drug classes [such as acetylsalicylic acid-NSAIDs (ASA-NSAIDs), non-β-lactams antibiotics, heparin, glucocorticoids, and local anesthetic agents]. In view of the decreased sensitivity of skin testing, limited accessibility to new benzylpenicillin polylysine (PPL)/mixture of minor determinant (MDM) test reagents and limited availability of validated sensitive in-vitro tests, individuals who require DPT to β-lactams are increasing. The negative predictive value of allergologic work-up is very high, ranging from 94 to 98% for β-lactams and those reactions after negative tests are mostly nonimmediate and mild. Finally, DPT is recommended to ascertain tolerability of alternative compound when evaluating cross-reactivity among different classes of β-lactams, NSAIDs and glucocorticoids, and possibly iodinated contrast media.
  
  
  CONCLUSIONS
  DPT is often needed when evaluating patients with suspected drug HSR. More studies regarding standardization of the various protocols are needed in order to increase its acceptance and adoption as a standard practice in the diagnostic algorithm for drug HSR.
authors.affiliation: Allergy Immunology and Rheumatology Division, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. tichalim@hotmail.com
authors.forename: Ticha
authors.initials: T
authors.lastname: Rerkpattanapipat
authors.forename: Anca-Mirela
authors.initials: AM
authors.lastname: Chiriac
authors.forename: Pascal
authors.initials: P
authors.lastname: Demoly
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D003287:Contrast Media / Q000009:adverse effects; D003888:Desensitization, Immunologic; D064907:Diagnostic Uses of Chemicals; D004306:Dose-Response Relationship, Immunologic; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000628:therapy; D064420:Drug-Related Side Effects and Adverse Reactions; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012882:Skin Tests; D014283:Triiodobenzoic Acids / Q000009:adverse effects; D047090:beta-Lactams / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003287:Contrast Media; D064907:Diagnostic Uses of Chemicals; D005938:Glucocorticoids; D004364:Pharmaceutical Preparations; D014283:Triiodobenzoic Acids; D047090:beta-Lactams; D001241:Aspirin