Basics of Skin Testing and Drug Challenges

In addition to the clinical history, skin testing and/or drug challenges are an important component in the evaluation and management of adverse drug reactions. Although skin testing to drugs plays an important role in the evaluation and management of adverse drug reactions, the diagnostic value of skin testing to various medications is dependent on the drug of interest. The best studied skin testing to a medication is penicillin, which has been shown to have a >90% negative predictive value for IgE-mediated adverse drug reactions. Drug challenges to the medication are the gold standard in determining the culprit medication and/or to determine the tolerance of medications in the evaluation and management of adverse drug reactions and have been shown to be safe when performed by a trained professional in the appropriate clinical situation. In this chapter, we describe and discuss the role of skin testing and/or drug challenges of various medications in the evaluation and management of adverse drug reactions.