Drug-induced exanthems: Correlation of allergy testing with histologic diagnosis - 23/10/13
, Christian Rose, MD b, Andreas Kerstan, MD c, Axel Trautmann, MD cAbstract |
Background |
Skin biopsies are commonly performed to confirm drug-induced exanthem (DIE). However, the relevance of histologic examination in discriminating between DIE and non-DIE (NDIE) is controversial.
Objective |
A retrospective analysis was performed to evaluate the reliability of histologic diagnosis of DIE.
Methods |
In all, 91 patients with a skin biopsy specimen of an acute exanthem temporally related to a single identifiable drug underwent complete allergy testing. Their biopsy specimens were retrospectively re-evaluated by 2 dermatopathologists blinded to the original reports to test for discrimination between DIE versus NDIE.
Results |
In 35 patients, non-IgE-mediated drug allergy was confirmed by allergy testing, whereas in 56 patients drug hypersensitivity could be excluded. Sensitivity of pathology reports for diagnosis of DIE reached 62.9% with a positive predictive value of 40.7%. Specificity was 41.1% with a negative predictive value of 69.7%. No significant difference in tissue eosinophilia was detected between DIE and NDIE.
Limitations |
This was a retrospective study.
Conclusions |
Dermatopathologic evaluation of skin biopsy specimens is of limited use in differentiating between DIE and NDIE. All efforts should be made to subject these patients to thorough allergy testing for definitely confirming or ruling out drug hypersensitivity.
Le texte complet de cet article est disponible en PDF.Key words : challenge testing, drug allergy, drug eruption, drug rash, drug reaction, eosinophils, exanthem, histopathology, provocation testing, skin testing
Abbreviations used : DIE, LTT, NDIE
Plan
| Funding sources: None. |
|
| Conflicts of interest: None declared. |
Vol 69 - N° 5
P. 721-728 - novembre 2013 Retour au numéro
Article précédent
- Pruritus in patients treated with targeted cancer therapies: Systematic review and meta-analysis
- Courtney J. Ensslin, Alyx C. Rosen, Shenhong Wu, Mario E. Lacouture
- Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics
- Philip J. Mease, Dafna D. Gladman, Kim A. Papp, Majed M. Khraishi, Diamant Thaçi, Frank Behrens, Robert Northington, Joanne Fuiman, Eustratios Bananis, Robert Boggs, Daniel Alvarez
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?