NIRs
The biggest changes were made throughout the diagnosis of NIR to BLs. In the last couple of years, lots of papers have been published which have shown that direct oral DPTs without prior skin testing are safe and effective in confirming or excluding hypersensitivity to BLs in children with benign rashes.16 -26 Some authors still think that a skin test with the culprit BL is safe and that it should be performed (as an extra security step) in children with NIR, to avoid exposing them directly to higher doses of suspected BLs, by DPT. 8,25, 27, 28 Another disagreement is the protocol for performing DPT. The optimal (incremental or full) doses and intervals between the doses are controversial. The length of DPT varies among the different studies, going from as short as 116,20,29,30 day to 5 18, 23, 26, 31or more days,6, 24 or the same length of the index reaction.24,30
There is general agreement that diagnostic work up should be performed for a minimum of 4 to 6 weeks after reaction to avoid both false-positive, false negative and flare-ups of systemic reactions.32
In the last few years there haven’t been major changes in the diagnosis SCARs induced by BLs. Patch tests are useful in diagnosis AGEP and DRESS, but they have low sensitivity (<30%) in diagnosis SJS/TEN. Intradermal tests are potentially useful in AGEP, their safety is unknown in DRESS, and contraindicated in SJS/TEN. DPTs are contraindicated in SCARs.32, 33
In vitro test, such as IFN-gamma producing cells determination by enzyme-linked immunospot assay (ELISpot), in combination with patch tests has demonstrated a potential utility in BLs induced SCARs. The sensitivity and specificity of the lymphocyte transformation test (LTT) is still unsatisfactory.2,15