PATCH TESTS UNDER SYSTEMIC IMMUNOSSUPRESSION – AN ABSOLUTE CONTRA-INDICATION?
Introduction: Epicutaneous patch tests are the gold standard for the diagnosis of allergic contact dermatitis. Ideally, the tests should be performed without concomitant systemic imunossupression, which is not possible in some clinical situations. There are no guidelines on how to perform the tests or evaluate the results in such cases. We aimed to review the literature concerning patch testing under iatrogenic immunossuppression.
Material and methods: Literature review of Medline indexed publications related to the subject until January 2015.
Results: According to published data, patch testing was performed in 77 patients under systemic corticosteroid, 78 under cyclosporine (CyA), 6 under azathioprine, 10 under metothrexate (MTX), 4 under mycophenolate mofetil (MMF), 11 under anti tumoral necrosis factor agents and 7 under IL-12/23 inhibitor. Additionaly, 15 patients under association of immunosuppressors also underwent patch testing. Positive reations were observed in all groups.
Conclusion: Ongoing treatment with immunossuppressants should not be an absolute contra-indication for patch testing, as positive reactions can be elicited in patients treated with prednisolone, azathioprine, CyA, MTX, MMF, infliximab, etanercept, adalimumab and ustecinumab. Negative or doubtful results should be interpreted with more cautious.
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