Clinical Communications
The safety of antibiotic skin testing in severe T-cell–mediated hypersensitivity of immunocompetent and immunocompromised hosts

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    Until recently, international guidelines have recommended that both pediatric and adult patients with benign reactions to BL should undergo ST and, if negative, a subsequent DPT. However, recent studies have demonstrated the safety of direct DPTs without preceding ST for both pediatric and adult patients who report a low-risk historical reaction to BLs.29,44-49,55,66-79 Most reactions that occur during DPTs are mild.29,40-43,64,83-85

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    Previous case reports of PPZ-TZB hypersensitivity occurring on both occupational skin contact and inhalation4,5 prompt suggestions that PPZ-TZB may have a significant potential to elicit hypersensitivity in this way. Although skin testing in DRESS has historically been avoided, we found it was safe in the vast majority of patients, for both IHR and NIHR; none of the patients with NIH and only 1 patient with IH (with a history of occupational exposure) had a systemic reaction with ST. This confirms findings for antibiotic testing in general.34,35 Our results emphasize, once more, both the critical clinical value and the safety of ST and further strengthen the recommendation for skin testing before considering drug provocation.21,22

  • Delabeling Delayed Drug Hypersensitivity: How Far Can You Safely Go?

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    In a recent consensus guideline, there was agreement amongst international experts that delayed IDT using sterile preparations of drugs can aid drug allergy assessment and that similar to PT should not be performed sooner than 4 to 6 weeks after an acute reaction.1 The use of IDT in SCAR has predominately been in the setting of hypersensitivity associated with anti-infective drugs that are commonly available as sterile preparations and for which the greatest delabeling need exists.79 Prior studies have indicated that IDT has increased sensitivity over PT and this appears particularly true for antibiotic-associated DRESS and MPE.80,81

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This work was supported by the Austin Medical Research Foundation. J.A.T. is supported by a National Health and Medical Research Council (NHMRC) postgraduate scholarship (GNT 1139902) and a postgraduate scholarship from The National Centre for Infections in Cancer, National Health and Medical Research Council, Centre for Research Excellence (App 1116876). E.J.P. is supported in part by the National Institutes of Health (NIH) (award nos. 1P50GM115305-01 and 1R01AI103348-01), the NIH-funded Tennessee Center for AIDS Research (grant no. P30 AI110527), NIH grant number 1R13 AR071267-01, NHMRC, ACH2, and the Angela Anderson Foundation.

Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

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