KAAACI Standardization Committee Report on the procedures and applications of the diagnostic tests for drug allergy

Min-Suk Yang; Ga-Young Ban; Min-Hye Kim; Kyung-Hwan Lim; Hyouk-Soo Kwon; Woo-Jung Song; Jae-Woo Jung; Jeongmin Lee; Dong In Suh; Jae-Woo Kwon; Sae-Hoon Kim; Yoo Seob Shin; Hye-Ryun Kang; Tae-Bum Kim; Byung-Jae Lee; Ai-Young Lee; Hae-Sim Park; Sang-Heon Cho

doi:10.4168/aard.2017.5.5.239

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Yang, Ban, Kim, Lim, Kwon, Song, Jung, Lee, Suh, Kwon, Kim, Shin, Kang, Kim, Lee, Lee, Park, Cho, and Korean Academy of Asthma, Allergy and Clinical Immunology Standardization Committee: KAAACI Standardization Committee Report on the procedures and applications of the diagnostic tests for drug allergy

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Allergy Asthma Respir Dis 2017;5(5):239-247.

Published online: 5 September 2017

DOI: https://doi.org/10.4168/aard.2017.5.5.239

KAAACI Standardization Committee Report on the procedures and applications of the diagnostic tests for drug allergy

Min-Suk Yang¹, Ga-Young Ban², Min-Hye Kim³, Kyung-Hwan Lim⁴, Hyouk-Soo Kwon⁵, Woo-Jung Song⁶, Jae-Woo Jung⁷, Jeongmin Lee⁸, Dong In Suh⁹, Jae-Woo Kwon¹⁰, Sae-Hoon Kim¹¹, Yoo Seob Shin², Hye-Ryun Kang⁶, Tae-Bum Kim⁵, Byung-Jae Lee¹², Ai-Young Lee¹³, Hae-Sim Park², Sang-Heon Cho⁶; Korean Academy of Asthma, Allergy and Clinical Immunology Standardization Committee

¹Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea

²Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea

³Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

⁴Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea

⁵Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

⁶Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

⁷Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea

⁸Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea

⁹Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea

¹⁰Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea

¹¹Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

¹²Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

¹³Department of Dermatology, Dongguk University Ilsan Hospital, Goyang, Korea

Correspondence to: Yoo Seob Shin https://orcid.org/0000-0002-9855-3185 Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5155, Fax: +82-31-219-5154, E-mail: drsys93@naver.com

• This research was supported by a fund (A092076) by Research of Korea Centers for Disease Control and Prevention.

Received 25 April 201730 May 2017 Accepted 31 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diagnostic methods for drug allergy include the patient's history, in vivo skin test, in vitro laboratory test, and provocation test. How-ever, the history is often not reliable, procedures for in vivo and in vitro tests are not standardized, and provocation tests are some-times harmful to patients. Generally, skin prick and intradermal tests are useful for immediate reactions; in contrast, patch test and delayed reading of both skin prick and intradermal tests are helpful for delayed reactions. A drug provocation test is the gold standard for both responses, and it is necessary to be aware of exact indications and contraindications with appropriate drugs, doses, and intervals. To date, several methods have been developed to detect culprit agents for drug hypersensitivity reactions, but they are neither completely well validated nor standardized. Based on this awareness and necessity, the Korean Academy of Asthma, Allergy and Clinical Immunology launched the Standardization Committee to review the international guidelines and the literature, and then developed the consensus report on the procedures and applications of diagnostic tests for drug allergy.

Keywords: Drug hypersensitivity, Skin tests, Intradermal tests, Patch tests

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Fig. 1.

Diagnostic flow for semisynthetic penicillin allergy. BP, benzylpenicillin; AX, amoxicillin.

Fig. 2.

Diagnostic flow for patients with beta-lactam allergy before administering other beta-lactam antibiotics (modified from reference 8). For penicillin allergic patient before using cephalosporin (A), for cephalosporin allergic patient before using penicillin (B), and for cephalosporin allergic patient before using other cephalosporin (C).

Table 1.

Drug-free interval demanded for drugs decreasing reactivity of skin tests

Medication	Route	Immediate reaction	Nonimmediate reaction	Free interval
H1-antihistamines	Oral, intravenous	+	-	5 Days
β-adrenergic drugs	Oral, intravenous	+	-	5 Days
Glucocorticoids	Oral, intravenous	±	-
Long term	Oral, intravenous	±	+	3 Weeks
Short term, high dose	Oral, intravenous	±	+	1 Week
Short term, <50 mg∗	Oral, intravenous	±	-	3 Days
Topical corticosteroids	Oral, intravenous	±	+	>2 Weeks

^∗ Prednisolone equivalent dose.

Table 2.

Scoring of patch test reactions

Clinical feature	Score	Conclusion
Faint erythema only	? or + ?	Doubtful reaction
Erythema, infiltration, possible discrete papules	+	Weak positive reaction
Erythema, infiltration, papules, vesicles	++	Strong positive reaction
Intense erythema, infiltration, coalescing vesicles	+++	Extreme positive reaction
Intense erythema, infiltration, coalescing vesicles	–	Negative reaction

+, ++, +++ are regarded as positive skin test reactions and – as a negative reaction.

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