Skin testing to narcotics
Question:
1/31/2020
A 50 year-old patient had codeine and morphine three times in the past and it caused severe abdominal pain, vomiting and shortness of breath. Skin test to codeine is strongly positive. How accurate is skin test? I am hesitant to do an oral challenge. She is going to have surgery. What alternative pain killer can she use?
Answer:
As you are likely aware, opioids can lead to non-specific mast-cell degranulation. Therefore, skin prick testing has little value in the evaluation of potential opioid allergy. Li et al demonstrated that challenge plays an important role in patients with history of possible opioid allergy in JACI: In Practice. In terms of alternatives, if narcotic medications are needed, can consider a synthetic opioid such as fentanyl. However, this is not completely without risk. It is also important to consider whether your patient could have underlying mast cell disorder leading to symptoms with opioids.
Li, Philip H. et al. Opioid Hypersensitivity: Predictors of Allergy and Role of Drug Provocation Testing. The Journal of Allergy and Clinical Immunology: In Practice, Volume 5, Issue 6, 1601 - 1606. 2017.
Hope this is helpful.
Regards,
Daniel J. Jackson, MD, FAAAAI