Predicting which medication classes interfere with allergy skin testing
Abstract:Medications often interfere with allergy skin test interpretation. This study was performed to determine which medications interfere with allergy skin tests. We retrospectively reviewed skin-prick test results from patients who had discontinued H1-antagonists, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, atypical antidepressants, antipsychotics, hypnotics, sedatives, proton pump inhibitors (PPIs), and H2-antagonists between 0 and 7 days before allergy skin testing. Ninety-seven subjects had taken second-generation H1-antihistamines within 7 days of skin testing; all patients who had stopped 3 days before testing had positive histamine controls. Two hundred sixty-eight skin tests performed on patients taking a single medication of interest showed that patients had the following percentages of a positive histamine control: TCAs, 56.5%; SNRIs, 100%; H2-blockers, 100%; SSRIs, 97%; PPIs, 97%; benzodiazepines, 85.7%; and atypical antidepressants/sedatives, 92.6%. The 580 patients taking multiple medications of interest showed that the odds ratio and 95% confidence intervals of a negative histamine test for patients taking TCAs were 6.33 (2.11‐20.5), for H1-blockers were 4.95 (1.78‐15.1), for benzodiazepines were 5.01 (1.72‐15.80), for atypical antidepressants/sedatives were 3.11 (1.09‐9.61), and for H2-blockers were 2.91 (0.97‐9.37). The odds of a negative histamine test for SSRIs, SNRIs, or PPIs were not significantly increased. SSRIs, SNRIs, and PPIs are unlikely to interfere with skin testing. TCAs, H1-blockers, benzodiazepines, quetiapine, and mirtazapine should be discontinued temporarily if clinically able. H2-antagonists, bupropion, eszopiclone, trazodone, or zolpidem showed minimal interference with immediate hypersensitivity skin test histamine response.
Keywords: Agents; antidepressive hypnotics and sedatives; antipsychotic agents; benzodiazepines; histamine antagonists; histamine response; hypersensitivity; immediate; negative control; proton pump inhibitors; skin tests
Document Type: Research Article
Affiliations: Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota, USA
Publication date: November 1, 2010
- Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.
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