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Spanish Society vision of Drug challenge tests

Audicana A1, Ortega N2, Lobera T3, Blanca N4, De la Parte B5, García I6, Gelis S7, Martín J8, Barranco R9, Vila C10, Laguna JJ11, On behalf of SEAIC Drug Allery Committee

1Servicio de Alergología e Inmunología Clínica, Hospital Universitario Araba, OSI Araba, Vitoria, Spain
2Servicio de Alergología, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain
3Sección de Alergología, Hospital Universitario de San Pedro, Logroño, La Rioja, Spain
4Servicio de Alergología, Hospital Universitario Infanta Leonor, Madrid, Spain
5Servicio de Alergología, Hospital del Tajo, Aranjuez, Spain
6Servicio de Alergología, Hospital Quirón Salud Campo de Gibraltar y Hospital Quiron Salud Córdoba, Spain
7Unidad de Alergia, Servicio de Neumología, Hospital Clinic, Institut d’investigacions Biomediques August Pi i Sunyer (IDIPAPS), Barcelona, Spain
8Servicio de Alergología, Hospital San Rafael, La Coruña, Spain
9Servicio de Alergología, Hospital Universitario 12 de Octubre, Madrid, Spain
10Unidad de Alergia, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
11Unidad de Alergia, Unidad de Alergoanestesia, Hospital Central de la Cruz Roja, Madrid, Spain

J Investig Allergol Clin Immunol 2021; Vol. 31(5)
doi: 10.18176/jiaci.0681

The controlled drug exposure test (DPT) is currently considered the gold standard for the diagnosis of drug allergy. Drug-induced adverse reactions (ADRs) are a growing reason for consultation in both primary and specialized care. Allergology consultations in Spain are the ones that usually study these ADRs and rule out immunological mechanisms involved in up to 90% of the cases consulted. An adequate approach to these cases has an obvious impact on the costs and efficacy of the treatments required by other specialists, so that if we did not use DPTs, patients would require more expensive, more toxic and less effective treatments in most of the cases.
In recent years, a large number of new drugs have been developed and this document is intended to be a practical guide in the management of PDT with the vision of the Spanish Allergology Society. Diagnostic work begins with a detailed history of the patient. Skin tests are only useful for some medications, and in most cases the diagnosis can only be confirmed by DPT. Although there is usually cross-reactivity, DPTs can confirm the diagnosis and also help to find a tolerable alternative drug. The individual management of patients in a programmed way, taking into account both the type of drug to be studied and the patient's comorbidities, usually allows a solution to be found for the majority of patients.

Key words: Drug-controlled exposure tests, Adverse drug reaction, Drug allergy diagnosis