Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations.

A drug provocation test (DPT) is the controlled administration of a drug in order to diagnose drug hypersensitivity reactions. DPTs are performed under medical surveillance, whether this drug is an alternative compound, or structurally/pharmacologically related, or the suspected drug itself. DPT is sometimes termed controlled challenge or reexposure, drug challenge, graded or incremental challenge, test dosing, rechallenge, or testing for tolerance. DPT is recommended by some specialized centers, allergy societies, and text books, whereas other societies advise against performing DPTs, and some review articles and textbooks do not even mention the method. The topic DPT is controversial in general and the test procedures not validated in most instances. Therefore it is considered important to develop general guidelines for performing DPT. Specific protocols for every single drug or at least group of drugs would be helpful, where indication, contraindication, substance, dosing, grading of the reaction and test as well as scoring criteria are defined. However, the development of individual DPT protocols is impractical because of the countless drugs that may cause numerous kinds of hypersensitivity reactions, allergic and non-allergic, with different time courses, severity and outcome, the individual situation of every person, and other factors that might possibly influence the test reaction. This paper sets out general guidelines for DPT that can be adapted for the specific problem under investigation.