Outcomes and safety of drug provocation tests.

Abstract

Drug provocation tests (DPTs) are considered the gold standard for identifying adverse drug reactions (ADRs). The aim of this study was to analyze DPT results and discuss severe systemic reactions associated with them. This was a retrospective analysis of 500 patients with ADRs who sought treatment and were submitted to DPTs when indicated between 2006 and 2010. We performed DPTs according to the European Network for Drug Allergy recommendations. Single-blind, placebo-controlled DPTs were performed with antibiotics, local anesthetics, and nonsteroidal anti-inflammatory drugs, as well as with other drugs. Patient characteristics, DPT results, and reactions were analyzed. The sample comprised 198 patients (80.8% of whom were female patients) submitted to 243 DPTs. Ages ranged from 9 to 84 years (mean, 39.9 years). The 243 DPTs were performed with local anesthetics (n = 93), antibiotics (n = 19), acetaminophen (n = 44), benzydamine (n = 33), COX-2 inhibitors (n = 26), dipyrone (n = 7), aspirin (n = 4), or other drugs (n = 17). The results of 4 tests (1.6%) were inconclusive, whereas those of 10 (4.1%) revealed positive reactions to antibiotics (2/19), COX-2 inhibitors (2/26), acetaminophen (3/44), and local anesthetics (3/93). Two severe reactions were observed: cephalexin-induced anaphylactic shock and bupivacaine-induced anaphylaxis without shock. Four patients (2.0%) reacted to the placebo before administration of the drug. Drug provocation tests are safe for use in clinical practice but they should be placebo-controlled and should be performed under the supervision of an allergist. To confirm a presumptive diagnosis and to manage allergies appropriately, it is crucial to perform DPTs.

• Authors: Marcelo Vivolo Aun, Carla Bisaccioni, Laila Sabino Garro, Adriana Teixeira Rodrigues, Luciana Kase Tanno, Luis Felipe Chiaverini Ensina, Jorge Kalil, Antônio Abílio Motta, Pedro Giavina-Bianchi
• Journal: Allergy and asthma proceedings (Allergy Asthma Proc) 2011 Jul-Aug Vol. 32 Issue 4 Pg. 301-6 ISSN: 1539-6304 [Electronic] United States
• PMID: 21781406 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Anesthetics, Local
• Anti-Bacterial Agents
• Anti-Inflammatory Agents, Non-Steroidal
• Pharmaceutical Preparations

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anaphylaxis (epidemiology)
• Anesthetics, Local (administration & dosage, adverse effects)
• Anti-Bacterial Agents (administration & dosage, adverse effects)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects)
• Child
• Drug Hypersensitivity (diagnosis)
• Drug-Related Side Effects and Adverse Reactions
• Female
• Humans
• Hypersensitivity, Immediate (chemically induced, epidemiology)
• Male
• Middle Aged
• Pharmaceutical Preparations (administration & dosage)
• Retrospective Studies
• Single-Blind Method
• Skin Tests (methods)
• Young Adult