Patch tests in nonimmediate cutaneous adverse drug reactions: The importance of late readings on day 4

Background Patch tests (PTs) with two readings have been used for decades to identify the culprit drug in nonimmediate cutaneous adverse drug reactions (NICADRs), followed more recently by late reading of intradermal tests (IDTs). Some teams tend to perform PTs with only one reading before IDTs or even directly perform IDTs. Objectives To evaluate the relevance of a late PT reading on day 4 (D4) in NICADRs. Methods We retrospectively selected patients who had a PT for an NICADR between July 2014 and March 2020. Results During the study period, 328 patients had a PT with available results. Among the 75 positive‐PT patients with available data for the two readings, 41 (54.7%) had positive results on D2 and D4 and 34 (45.3%) had negative results on D2 but positive results on D4. No patient had positive results on D2 and negative results on D4. Conclusion This study shows that a D4 reading enhanced the PT‐positive results. A positive PT result allows for reducing the number of IDTs, which are more difficult and costly to perform. Our series suggests that a late PT reading at D4 should be performed for exploring NICADRs. Nearly half of the positive patch tests performed for exploring nonimmediate cutaneous adverse drug reactions (NICADRs) were positive only on day 4 (D4) The time to positivity of patch tests did not depend on the type of NICADR or the drugs tested This result highlights the need for a late patch‐test reading to avoid false‐negative results and unnecessary intradermal tests.