title: Predicting which medication classes interfere with allergy skin testing.
abstract: Medications often interfere with allergy skin test interpretation. This study was performed to determine which medications interfere with allergy skin tests. We retrospectively reviewed skin-prick test results from patients who had discontinued H(1)-antagonists, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, atypical antidepressants, antipsychotics, hypnotics, sedatives, proton pump inhibitors (PPIs), and H(2)-antagonists between 0 and 7 days before allergy skin testing. Ninety-seven subjects had taken second-generation H(1)-antihistamines within 7 days of skin testing; all patients who had stopped 3 days before testing had positive histamine controls. Two hundred sixty-eight skin tests performed on patients taking a single medication of interest showed that patients had the following percentages of a positive histamine control: TCAs, 56.5%; SNRIs, 100%; H(2)-blockers, 100%; SSRIs, 97%; PPIs, 97%; benzodiazepines, 85.7%; and atypical antidepressants/sedatives, 92.6%. The 580 patients taking multiple medications of interest showed that the odds ratio and 95% confidence intervals of a negative histamine test for patients taking TCAs were 6.33 (2.11-20.5), for H(1)-blockers were 4.95 (1.78-15.1), for benzodiazepines were 5.01 (1.72-15.80), for atypical antidepressants/sedatives were 3.11 (1.09-9.61), and for H(2)-blockers were 2.91 (0.97-9.37). The odds of a negative histamine test for SSRIs, SNRIs, or PPIs were not significantly increased. SSRIs, SNRIs, and PPIs are unlikely to interfere with skin testing. TCAs, H(1)-blockers, benzodiazepines, quetiapine, and mirtazapine should be discontinued temporarily if clinically able. H(2)-antagonists, bupropion, eszopiclone, trazodone, or zolpidem showed minimal interference with immediate hypersensitivity skin test histamine response.
authors.affiliation: Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota, USA. shah.kunal@mayo.edu
authors.forename: Kunal M
authors.initials: KM
authors.lastname: Shah
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Rank
authors.forename: Shoban A
authors.initials: SA
authors.lastname: Davé
authors.forename: Corrine L
authors.initials: CL
authors.lastname: Oslie
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Butterfield
mesh_terms: D002491:Central Nervous System Agents / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D003951:Diagnostic Errors / Q000517:prevention & control; D004347:Drug Interactions; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012882:Skin Tests; D028761:Withholding Treatment
chemical_list: D002491:Central Nervous System Agents; D039563:Histamine H1 Antagonists, Non-Sedating; D006635:Histamine H2 Antagonists