title: Clinical characteristics and outcomes of patients undergoing drug provocation tests (DPTs).
abstract: BACKGROUND
  Patients who have an adverse drug reaction are frequently labelled drug allergic without undergoing proper evaluation and confirmatory testing. These drug allergy labels may be inaccurate, leading to unnecessary lifelong avoidance. The aim of this study was to review the patients that underwent drug provocation tests (DPTs) in our centre and examine the usefulness of DPTs in confirming or rejecting a diagnosis of drug hypersensitivity.
  
  
  METHODS
  The study design was a retrospective chart review of all adult patients who underwent drug provocation in the allergy unit at the National University Hospital, Singapore, for single or multiple suspected drug allergies from the period January 2009 to June 2011.
  
  
  RESULTS
  Eighty-seven patients underwent 123 DPTs (median age 41; interquartile range 28 to 50). Twenty-one patients underwent multiple DPTs. The most common culprit drugs reported were antibiotics (43.9%) of which beta-lactams were implicated in 75.9% of the cases. This was followed by non-steroidal anti-inflammatory drugs (NSAIDS) in 15.4%, paracetamol in 7.3% and both NSAIDs and paracetamol in 3.3%. Rash was the most commonly reported symptom (41.5%), followed by angioedema (32.5%), anaphylaxis (9.8%), and other symptoms including respiratory (2.4%), gastrointestinal (0.8%) and others (13.0%). The majority of DPTs were performed to antibiotics (43.9%), NSAIDs (19.5%) and paracetamol (6.5%). DPTs were negative in 93.5% of subjects and positive in 6.5%. Of the 8 positive DPTs, none had a serious reaction, with 5 patients requiring rescue therapy, which comprised solely of oral antihistamines.
  
  
  CONCLUSIONS
  Suspected drug hypersensitivity is common but true drug allergy is rare. DPTs remain the gold standard and should be included as part of an investigative protocol. DPTs are a safe and valuable diagnostic tool in the hands of the experienced clinician.
authors.affiliation: Department of Paediatrics, Division of Paediatric Allergy, Immunology and Rheumatology, National University Hospital, Singapore.
authors.forename: Meera
authors.initials: M
authors.lastname: Thalayasingam
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Davies
authors.forename: Genevieve V
authors.initials: GV
authors.lastname: Llanora
authors.forename: Irvin F
authors.initials: IF
authors.lastname: Gerez
authors.forename: Hugo P
authors.initials: HP
authors.lastname: Van Bever
authors.forename: Lynette P
authors.initials: LP
authors.lastname: Shek
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012846:Singapore; D012882:Skin Tests / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents