Protocol for skin testing with levothyroxine

How to prepare the solution?

Thyroxin solution for skin testing can be prepared by crushing a tablet (50 mcg) and mixing with 1 mL of 0.9% phosphate-buffered saline for 2 hours.

The solution can be passed through a 0.2-micrometer-pore filter if future IV administration is indicated. This should be done by a pharmacist.

How to do the skin test?

Prick test with levothyroxine solutiion, 50 mcg/mL. If negative, do intradermal testing with 0.02 mL of the solution in concentrations of 1:100,000, 1:10,000, 1:1,000, 1:100, and 1:10.

If the tests are negative, a challenge with levothyroxine should be performed if indicated.



Drug allergy management in 5 steps (click to enlarge the image).

References:

IMMEDIATE-TYPE HYPERSENSITIVITY REACTION TO LEVOTHYROXINE AND DESENSITIZATION - Annals of Allergy, Asthma & Immunology http://buff.ly/1BHCa1C

Levothyroxine anaphylaxis? Vocal cord dysfunction mimicking an anaphylactic drug reaction - Annals of Allergy, Asthma & Immunology http://buff.ly/1FF8r6F

Image source: Wikipedia, public domain.

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