This still depends largely on clinical criteria, history, type of reaction, response to withdrawal and systemic rechallenge (if thought safe to do so).
Simple patch skin testing is naturally most useful in diagnosing contact dermatitis, but it is unreliable for other allergies. Skin prick tests are helpful in specialist hands for diagnosing IgE-dependent drug reactions, notably due to penicillin, cephalosporins, muscle relaxants, thiopental, streptokinase, cisplatin, insulin and latex. They can cause anaphylactic shock. False positive results occur.
Development of reliable in-vitro predictive tests, e.g. employing serum or lymphocytes, is a matter of considerable importance, not merely to remove hazard but to avoid depriving patients of a drug that may be useful. Detection of drug-specific circulating IgE antibodies by the radioallergo-sorbent test (RAST) is best developed for penicillins and succinyl choline.
Drug allergy, once it has occurred, is not necessarily permanent, e.g. less than 50% of patients giving a history of allergy to penicillin have a reaction if it is given again.
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