title: Bisphosphonate-induced cutaneous adverse events: the difficulty of assessing imputability through patch testing.
abstract: BACKGROUND
  Cutaneous adverse drug reactions (CADRs) due to bisphosphonates (BPs) have been scarcely described in the literature.
  
  
  OBJECTIVE
  To discuss the diagnostic value and limitations of cutaneous provocation tests with BPs.
  
  
  METHODS
  A descriptive case series study with a control group of CADRs due to BPs studied using patch testing from 2005 to 2010 is presented.
  
  
  RESULTS
  Patient 1 showed a positive D4++ with alendronate at 1% in petrolatum and D4+++ with alendronate at 1 and 0.1% in water. Patient 2 showed a positive intradermal test D3++ with alendronate at 0.1% in water. Patient 3 showed a positive patch test D4+ with ibandronate at 1% in petrolatum and D4++ with ibandronate at 1% in water, and a positive intradermal test D3+++ with ibandronate at 0.1% in water.
  
  
  CONCLUSIONS
  Establishing a correct interpretation of a patch test reaction is difficult based just on cutaneous test results. Too high concentrations of the drug can cause irritation and too low concentrations can be responsible of false-negative test reactions.
authors.affiliation: Department of Pharmacy, Hospital del Mar, IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Melisa
authors.initials: M
authors.lastname: Barrantes-González
authors.forename: Mercè
authors.initials: M
authors.lastname: Espona-Quer
authors.forename: Esther
authors.initials: E
authors.lastname: Salas
authors.forename: Ana María
authors.initials: AM
authors.lastname: Giménez-Arnau
mesh_terms: D000368:Aged; D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D008297:Male; D010328:Patch Tests / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D004164:Diphosphonates; D000077557:Ibandronic Acid; D019386:Alendronate