Generalized reactions during skin testing with clindamycin in drug hypersensitivity: a report of 3 cases and review of the literature
- 22 January 2018
- journal article
- research article
- Published by Wiley in Contact Dermatitis
- Vol. 78 (4), 274-280
- https://doi.org/10.1111/cod.12956
Abstract
The diagnostic approach to drug hypersensitivity includes a detailed medical history, clinical examination, and skin testing and/or oral challenge with a culprit or alternative drug, depending on the type of reaction and the suspected drugs. Although skin testing is considered to be rather safe, cutaneous and systemic, including fatal, reactions have been described. To report 3 cases with generalized delayed reactions after skin testing with clindamycin, and to review the existing literature. Thorough clinical examination, blood tests and prick, intradermal and patch tests were performed in 3 patients. All patients experienced generalized maculopapular exanthema after intradermal and patch testing with clindamycin and amoxicillin in the first patient, and clindamycin alone in the second and third patients. None of the patients showed immediate reactions to skin tests, while positive intradermal reactions after 24 h to amoxicillin and clindamycin were observed in the first patient, and positive intradermal reactions after 24 h to clindamycin were observed in the second and third patients. Skin testing with clindamycin in the diagnosis of drug hypersensitivity carries some risk of adverse reactions. A stepwise and individual diagnostic work-up, considering potential risk factors, and testing in a specialized centre with emergency equipment available is highly recommended.Keywords
This publication has 31 references indexed in Scilit:
- Ceftriaxone intradermal test‐related fatal anaphylactic shock: a medico‐legal nightmareAllergy, 2009
- Patch Testing in Non-Immediate Drug EruptionsAllergy, Asthma & Clinical Immunology, 2008
- Nonimmediate reactions to betalactamsCurrent Opinion in Allergy and Clinical Immunology, 2007
- Clindamycin skin testing has limited diagnostic potentialContact Dermatitis, 2005
- Drug patch testing in systemic cutaneous drug allergyToxicology, 2005
- Nonirritating intradermal skin test concentrations for commonly prescribed antibioticsJournal of Allergy and Clinical Immunology, 2003
- Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerationsAllergy, 2003
- Diagnosing Nonimmediate Reactions to Penicillins by in vivo TestsInternational Archives of Allergy and Immunology, 2002
- A revised nomenclature for allergy: An EAACI position statement from the EAACI nomenclature task forceAllergy, 2001
- Frequency of systematic reactions to penicillin skin testsAnnals of Allergy, Asthma & Immunology, 2000