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. 2020 Oct 29;10(4):e44. doi: 10.5415/apallergy.2020.10.e44

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.