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Table 4 Precautions and contraindications of performing drug provocation tests (DPTs) (from ICON with permission [4])

From: Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America

DPTs are contraindicated in non-controllable and/or severe life-threatening DHRs Severe cutaneous reactions, such as SJS, TEN, DRESS, vasculitis, AGEP Systemic reactions such as DRESS, any internal organ involvement, hematological reactions Anaphylaxis may be tested after discussion with patient of risk and benefits
DPTs are not indicated The offending drug is unlikely to be needed and several structurally unrelated alternatives exist Severe concurrent illness or pregnancy (unless the drug is essential for the concurrent illness or required during pregnancy or delivery)
DPTs should be performed under the highest safety conditions Trained staff that are: familiar with allergy tests, can identify early signs of a positive reaction, and can manage life-threatening allergic reactions Emergency resuscitative equipment should be available
  1. DHRs drug hypersensitivity reactions, SJS Stevens–Johnson syndrome, TEN toxic epidermal necrolysis, DRESS drug reaction with eosinophilia and systemic symptoms, AGEP acute generalized exanthematous pustulosis