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Intradermal Tests for Diagnosis of Drug Allergy are not Affected by a Topical Anesthetic Patch
Mariana Couto,Diana Silva,Ana Ferreira,Josefina R. Cernadas 대한천식알레르기학회 2014 Allergy, Asthma & Immunology Research Vol.6 No.5
The use of topical anesthesia to perform intradermal tests (IDTs) for drug allergy diagnosis was never investigated. We aimed to determine the effectsof a topical anesthetic patch containing prilocaine-lidocaine on wheal size of IDT with drugs. Patients who had positive IDT as part of their investigationprocess of suspected drug hypersensitivity were selected. IDT were performed according to guidelines. Anesthetic patch (AP) wasplaced and the same prior positive IDT, as well as positive histamine skin prick test (SPT) and negative (saline IDT) controls, were performed in theanesthetized area. Patients with negative IDT were also included to check for false positives with AP. Increase in wheals after 20 minutes both withand without AP was recorded and compared. 45 IDT were performed (36 patients), of which 37 have been previously positive (14 antibiotics, 10 generalanesthetics, 6 non-steroidal anti-inflammatory drugs, 3 iodinated contrasts, 3 anti-Hi-histamines and 1 ranitidine). Mean histamine SPT sizewithout the AP was 4.7 mm [95%CI (4.4-5.1)], and 4.6 mm [95%CI (4.2-5.0)] with anesthesia. Mean wheal increase in IDT for drugs without the anesthesiawas 4.5 mm [95%CI (3.3-5.7)] and with anesthesia was 4.3 mm [95%CI (2.8-5.8)]. No statistical significant differences were observed betweenskin tests with or without AP for histamine SPT (P=0.089), IDT with saline (P=0.750), and IDT with drugs (P=0.995). None of the patientswith negative IDT showed positivity with the AP, or vice-versa. The use of an AP containing prilocaine-lidocaine does not interfere with IDT to diagnosedrug allergy, and no false positive tests were found.