IRs
For IR there are agreement that the skin (prick and intradermal) tests with culprit BL, should be performed before confirmatory oral drug provocation test- DPT.3,5, 6, 9,12 Skin tests have a relatively high diagnostic value in IRs 6,13, but more pediatric studies need to confirm these data. The DPT is still the gold standard for the diagnosis of IRs, 3, 6, 11, 13 but there is no consensus on the best protocol for performing DPT. It is still necessary to establish the optimal step doses and the optimal duration of provocation.3 General recommendation for DPT, including indications and contraindications, also apply for children.14
In vitro testing is a part of a diagnostic algorithm for IRs to BLs along with other tests. Quantification of serum drug-specific IgE (sIgE) measurements and direct/indirect basophil activation tests (BATs) are frequently not performed. At the present time, there is controversy regarding sIgE immunoassay. sIgE immunoassay in some European countries is recommended for evaluating IRs to BLs, but in United States, it is not used because of its suboptimal sensitivity and low concordance with skin tests and DPTs.2,15