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