Are skin tests useful for diagnosis of hypersensitivity reactions to analgesics-antipyretics-nonsteroidal anti-inflammatory drugs? No

Reactions to nonopioid analgesics, antipyretics and nonsteroidal anti-inflammatory drugs (NSAIDs) may result from a specific/allergic hypersensitivity (HS), either IgE-mediated (immediate and very early reactions) or mediated by T-lymphocytes (delayed reactions), or from a non-specific/non-allergic HS (pharmacological "intolerance"), with a frequent cross -reactivity between the various chemical families of drugs, including paracetamol and, sometimes, coxibs. In patients with suspected allergic HS, diagnosis is usually based on a convincing clinical history and/or provocation tests (PT) showing that the patients react to thIn patients with non-allergic HS, skin tests are useless and diagnosis is based on a convincing clinical history and/or responses in PT. Considering also the low diagnostic value of in vitro tests, diagnosis of HS to analgesics-antipyretics-NSAIDs, whether allergic or non-allergic, is primarily based on clinical history of the patients and their responses in PT, and international consensus do not recommend skin tests. (C) 2021 Elsevier Masson SAS. All rights reserved.e suspected drug (+other drugs in the same chemical family) but tolerate other (families of) drugs. However, although immediate and non-immediate-reading skin tests (ST) are specific when performed with non-irritant concentrations, they have a low sensitivity ( < 25-30 %) and are not validated.