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Paediatric Pulmonology and Allergology
2005 October, Vol. VIII, No. 2 (2939-2956)
DRUG PROVOCATION TESTING IN THE DIAGNOSIS OF DRUG HYPERSENSITIVITY REACTIONS: GENERAL CONSIDERATIONS
Violeta Kvedariene1,2, Remigijus Nargela1, Audra Blaziene1, Virginijus Svedas1,Pascal Demoly2,3
1 Vilnius University Hospital Santariðkiø klinikos, Vilnius, Lithuania;
2 Hôpital Arnaud de Villeneuve, Montpellier, France; 3 ENDA group
3 European Network for Drug Allergy (ENDA) – European Academy of Allergy and Clinical Immunology interest group on drug hypersensitivity: W. Aberer, B. K. Ballmer-Weber, A. Barbaud, B. Bilo, A. Bircher, J. Birnbaum, M. Blanca, B. Blömecke, K. Brockow, P. Campi, A. de Weck, C. Dzviga, M. Drouet, B. Eberlein-König, J. Fernandez, T. Frew, T. Fuchs, J. L. Guéant, C. Gutgesell, M. Hertl, G. Kanny, A. Kapp, M. Kidon, M. Kowalski, G. Marone, H. Merk, A. D. Moneret-Vautrin, C. Pascual- Marcos,W. J. Pichler, B. Przybilla, E. Rebelo-Gomes, J. Ring, A. Romano, F. Rueff, A. Sabbah, J. Sainte Laudy, M. Sanz, E. Tas, M. J. Torres, D. Vervloet, B. Wedi, B. Wüthrich.
Drug provocation test (DPT) is the controlled administration of a drug in order to diagnose drug hypersensitivity reactions. DPTs are performed under medical surveillance, whether the drug is an alternative compound, is structurally/pharmacologically related, or is the suspected drug itself. In general, the DPT topic is controversial and, in most cases, the test procedures are not validated. Therefore it is important to develop general guidelines for performing DPTs. A specific protocol for each different drug, or at least for each different group of drugs, would be helpful. The indication, contraindication, substance, dosing, grading of the reaction and test as well as the scoring criteria would therefore all be defined. This paper sets out general guidelines for DPTs that can be adapted to specific problems under investigation. Our aims are to define the rationale and general principles of DPTs and to propose recommendations based on evidence taken from published literature data and based on the clinical expertise of members of the ENDA (European Network for Drug Allergy: the core part of the EAACI drug hypersensitivity interest group). DPTs may help to optimise the pharmacotherapy of the patient concerned. They may also guide on the choice of therapy for future patients and generate new scientific knowledge.