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