title: Challenge test to bisphosphonates in patients with hypersensitivity reactions to drugs.
abstract: BACKGROUND
  Bisphosphonates are a commonly used class of drugs with known efficacy in the prevention and treatment of postmenopausal and steroid-induced osteoporosis, Paget's disease of bone, hypercaelcemia of malignancy, osteolytic lesions of multiple myeloma, and bone metastases. Nitrogen-containing bisphosphonates have a favourable tolerability and safety profile, cutaneous reactions have been reported.
  
  
  METHODS
  This is a retrospective case series study, based on the analysis of data from 1429 patients admitted to the Allergy and Clinical Immunology Division of the University of Messina between January 2011 and December 2012. Most patients had previous adverse drug reactions (ADRs) and referred to us for a challenge test with an alternative drug.
  
  
  RESULTS
  We observed six patients with a past history of adverse drug reaction who needed to be tested for bisphosphonates: three patients for risedronate, two for clodronate and one for alendronate. In two years only two patients were referred to us for an adverse reaction to bisphosphonates: one to alendronate and one to risedronate. Another patient presented a previous reaction to strontium ranelate. The other three patients reported previous hypersensitivity reactions to at least two different classes of drugs. All the patients experienced no reaction using the tested drugs.
  
  
  CONCLUSIONS
  In our experience drug challenge tests for bisphosphonates are safe and reliable.
authors.affiliation: Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy.
authors.forename: Paola Lucia
authors.initials: PL
authors.lastname: Minciullo
authors.affiliation: Division of Haematology, University of Messina, Messina, Italy. Electronic address: alessandro.allegra@tin.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Allegra
authors.affiliation: Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: D'Angelo
authors.affiliation: Division of Haematology, University of Messina, Messina, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Musolino
authors.affiliation: Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy; Institute of Biomedicine and Molecular Immunology "A. Monroy" (IBIM), Consiglio Nazionale delle Ricerche (CNR), Palermo, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Gangemi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004002:Clodronic Acid / Q000008:administration & dosage / Q000009:adverse effects; D004164:Diphosphonates / Q000627:therapeutic use*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage; D006801:Humans; D007114:Immunization; D007660:Ketoprofen / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D000068296:Risedronic Acid / Q000008:administration & dosage*; D012882:Skin Tests; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D006633:Histamine Antagonists; D013876:Thiophenes; C081587:strontium ranelate; D004002:Clodronic Acid; D007660:Ketoprofen; D000068296:Risedronic Acid; D019386:Alendronate
keywords: Bisphosphonates; Challenge test; Cutaneous reactions; Drug reaction; Hypersensitivity reactions; Safety