Table 3. Utilization of in vitro tests for severe DHRs in our clinical practice.
Immediate DHR | ||||||
DHRs manifestation | Possible culprits | In vitro-tested drugs | BAT | STs | DPT | |
Anaphylaxis | Lidocaine | Lidocaine | Negative | Negative | ND | |
Mepivacaine | Negative | Negative | Negative | |||
Final drug use: Mepivacaine | ||||||
Anaphylaxis | Iobitridol | Iobitridol | Negative | ND | ND | |
Iopromide | Negative | ND | Negative | |||
Iohexol | Negative | ND | ND | |||
Ioxagate | Negative | ND | ND | |||
Final drug use: Iopromide (no premed, no ADR) | ||||||
Possible Kounis syndrome | Amoxicillin/clavulanic | Amoxicillin | Negative | Negative | ND | |
Clavulanic | Negative | Negative | ND | |||
Continue to avoid amoxicillin/clavulanic | ||||||
Delayed-type DHR | ||||||
DHRs manifestation | Possible culprits | In vitro-tested drugs | LTT | STs | DPT | |
DRESS | IRZE | Isoniazid (I) | Negative | ND | Negative | |
Rifampicin (R) | Positive | ND | ND | |||
Ethambutol (E) | Negative | ND | Negative | |||
Pyrazinamide (Z) | Positive | ND | ND | |||
Levofloxacin (L) | Negative | ND | Negative | |||
Final regimen: IEL | ||||||
DRESS | IRZE | Isoniazid (I) | Negative | ND | Negative | |
Rifampicin (R) | Negative | ND | Negative | |||
Ethambutol (E) | Negative | ND | Negative | |||
Pyrazinamide (Z) | Positive | ND | ND | |||
Levofloxacin (L) | Positive | ND | ND | |||
Final regimen: IRE |
DHR, drug hypersensitivity reaction; BAT, basophil activation test; ST, skin test; DPT, drug provocation test; ND, not determined; ADR, adverse drug reaction; DRESS, drug reaction with eosinophilia and systemic symptoms; LTT, lymphocyte transformation test; IRZE, isoniazid, rifampicin, pyrazinamide, ethambutol.