Pro and Contra: Provocation Tests in Drug Hypersensitivity

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Soyer O., Sahiner Ü. M., Sekerel B. E.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, vol.18, no.7, 2017 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 18 Issue: 7
  • Publication Date: 2017
  • Doi Number: 10.3390/ijms18071437
  • Journal Name: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Keywords: drug hypersensitivity reaction, provocation test, anaphylaxis, NONSTEROIDAL ANTIINFLAMMATORY DRUGS, BETA-LACTAM ANTIBIOTICS, IGE-MEDIATED HYPERSENSITIVITY, NEGATIVE PREDICTIVE-VALUE, DETERMINING SAFE ALTERNATIVES, CHRONIC SPONTANEOUS URTICARIA, IMMEDIATE ALLERGIC REACTIONS, BASOPHIL ACTIVATION TEST, SKIN-TEST CONCENTRATIONS, PENICILLIN ALLERGY
  • Hacettepe University Affiliated: Yes

Abstract

Drug provocation test (DPT) is the controlled administration of a drug to diagnose immune-or non-immune-mediated drug hypersensitivity and the last step for accurate recognition of drug hypersensitivity reactions when the previous diagnostic evaluations are negative or unavailable. A DPT is performed only if other conventional tests fail to yield conclusive results. In each clinical presentation, "to provoke or not to provoke" a patient should be decided after careful assessment of the risk-benefit ratio. Well-defined benefits of DPT include confirmative exclusion of diagnoses of drug hypersensitivity and provision of safe alternatives. However, disadvantages such as safety, difficulty in interpretations of results, lack of objective biomarkers, risks of resensitization, efficiency in daily practice, and lack of standardized protocols, are poorly debated. This review summarizes the current published research concerning DPT, with particular emphasis on the advantages and disadvantages of DPT in an evidence-based manner.