Cynthia Haddad

Haudrey Assier

Jean‐Claude Roujeau

Laurence Valeyrie‐Allanore

Olivier Chosidow

Pierre Wolkenstein

Clinical and Translational Allergy

PubMed

Jean-Claude Roujeau

Laurence Valeyrie-Allanore

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Usefulness of patch tests in drug adverse reaction
induced by tetrazepam and anti-inflammatory
drugs
Haudrey Assier1*, Cynthia Haddad2, Jean-Claude Roujeau2, Pierre Wolkenstein2, Olivier Chosidow2,
Laurence Valeyrie-Allanore2
From 6th Drug Hypersensitivity Meeting (DHM 6)
Bern, Switzerland. 9-12 April 2014
Skin testing with the suspected drugs may be helpful in
determining the cause of a cutaneous adverse reaction
(CADR). Tetrazepam (T) is a muscle relaxant of the ben-
zodiazepine group frequently used in rheumatology in
association with anti-inflammatory drugs (AIDs). We
propose to determine the usefulness of patch testing in
this context. Patients and methods A retrospective study
was conducted including all patients referred between
2000 and 2010 for patch testing after a CADR occurring
after concomitant administration of T and AIDs. Patch
test were performed at least 6 weeks after healing with T
and AIDs diluted at 10 % in petrolatum in a commercial
form (Chemotechnique Laboratory Diagnostics, Malmö,
Sweden) or crushed and diluted in petroleum. All
patients were contacted by letter in 2010 and data con-
cerning T or AID rechallenge, after the patch testing,
were collected. T patch testing was also performed on 10
controls, ie individuals who already took T but did not
present any CADR.
Results
15 subjects with a past history of CADR were referred for
patch testing with both T and AIDs possible / probable
culprit drugs. Among this patients, CADR included Ste-
vens Johnson/toxic epidermal necrolysis (5), maculopapu-
lar rash (7), Drug Reaction with Eosinophilia and Systemic
Symptoms (1) and Acute Generalized Exanthematous Pus-
tulosis (2). AIDs included ketoprofene (3), diclofenac (2),
rofecoxib (2), piroxicam (5), naproxène (1), prednisone (1),
cortivazol (1). Patch tests were positive for T and negative
for AIDs in 80 % of cases (12). Both patch tests were
negative in 20% (3). All the 10 control subjects had
negative patch test to T. Nine subjects answered to our
letter, none of them has been rechallenged with either T
or AIDs, whatever the results of the tests. Comments Posi-
tive T patch tests were obtained in 80% of cases whatever
the CARDs. This was much higher than the usual 30-50%
rate observed in the literature with miscellaneous drugs.
All the T exposed control subjects were negative as were
100 non exposed controls reported in literature. However,
its predictive value can not be determined in absence of
rechallenge after negative patch test. T CADR may be sys-
tematically suspected even in case of concomitant AIDs
intake. Readministration of AID could be allowed in non
severe CADR with negative AID patch testing and positive
one for T.
Authors’ details
1Department of dermatology, Henri Mondor Hospital, France. 2Henri Mondor
Hospital, Department of Dermatology, France.
Published: 18 July 2014
doi:10.1186/2045-7022-4-S3-P106
Cite this article as: Assier et al.: Usefulness of patch tests in drug adverse
reaction induced by tetrazepam and anti-inflammatory drugs. Clinical and
Translational Allergy 2014 4(Suppl 3):P106.
1Department of dermatology, Henri Mondor Hospital, France
Full list of author information is available at the end of the article
Assier et al. Clinical and Translational Allergy 2014, 4(Suppl 3):P106
http://www.ctajournal.com/content/4/S3/P106
© 2014 Assier et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


Usefulness of patch tests in drug adverse reaction induced by tetrazepam and anti-inflammatory drugs

Crossref

POSTER PRESENTATION Open AccessUsefulness of patch tests in drug adverse reactioninduced by tetrazepam and anti-inflammatorydrugsHaudrey Assier1*, Cynthia Haddad2, Jean-Claude Roujeau2, Pierre Wolkenstein2, Olivier Chosidow2,Laurence Valeyrie-Allanore2From 6th Drug Hypersensitivity Meeting (DHM 6)Bern, Switzerland. 9-12 April 2014Skin testing with the suspected drugs may be helpful indetermining the cause of a cutaneous adverse reaction(CADR). Tetrazepam (T) is a muscle relaxant of the ben-zodiazepine group frequently used in rheumatology inassociation with anti-inflammatory drugs (AIDs). Wepropose to determine the usefulness of patch testing inthis context. Patients and methods A retrospective studywas conducted including all patients referred between2000 and 2010 for patch testing after a CADR occurringafter concomitant administration of T and AIDs. Patchtest were performed at least 6 weeks after healing with Tand AIDs diluted at 10 % in petrolatum in a commercialform (Chemotechnique Laboratory Diagnostics, Malmö,Sweden) or crushed and diluted in petroleum. Allpatients were contacted by letter in 2010 and data con-cerning T or AID rechallenge, after the patch testing,were collected. T patch testing was also performed on 10controls, ie individuals who already took T but did notpresent any CADR.Results15 subjects with a past history of CADR were referred forpatch testing with both T and AIDs possible / probableculprit drugs. Among this patients, CADR included Ste-vens Johnson/toxic epidermal necrolysis (5), maculopapu-lar rash (7), Drug Reaction with Eosinophilia and SystemicSymptoms (1) and Acute Generalized Exanthematous Pus-tulosis (2). AIDs included ketoprofene (3), diclofenac (2),rofecoxib (2), piroxicam (5), naproxène (1), prednisone (1),cortivazol (1). Patch tests were positive for T and negativefor AIDs in 80 % of cases (12). Both patch tests werenegative in 20% (3). All the 10 control subjects hadnegative patch test to T. Nine subjects answered to ourletter, none of them has been rechallenged with either Tor AIDs, whatever the results of the tests. Comments Posi-tive T patch tests were obtained in 80% of cases whateverthe CARDs. This was much higher than the usual 30-50%rate observed in the literature with miscellaneous drugs.All the T exposed control subjects were negative as were100 non exposed controls reported in literature. However,its predictive value can not be determined in absence ofrechallenge after negative patch test. T CADR may be sys-tematically suspected even in case of concomitant AIDsintake. Readministration of AID could be allowed in nonsevere CADR with negative AID patch testing and positiveone for T.Authors’ details1Department of dermatology, Henri Mondor Hospital, France. 2Henri MondorHospital, Department of Dermatology, France.Published: 18 July 2014doi:10.1186/2045-7022-4-S3-P106Cite this article as: Assier et al.: Usefulness of patch tests in drug adversereaction induced by tetrazepam and anti-inflammatory drugs. Clinical andTranslational Allergy 2014 4(Suppl 3):P106.1Department of dermatology, Henri Mondor Hospital, FranceFull list of author information is available at the end of the articleAssier et al. Clinical and Translational Allergy 2014, 4(Suppl 3):P106http://www.ctajournal.com/content/4/S3/P106© 2014 Assier et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Usefulness of patch tests in drug adverse reaction induced by tetrazepam and anti‐inflammatory drugs

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Usefulness of patch tests in drug adverse reaction induced by tetrazepam and anti‐inflammatory drugs

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