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Núñez R, Doña I, Cornejo-García JA. Predictive models and applicability of artificial intelligence-based approaches in drug allergy. Curr Opin Allergy Clin Immunol 2024:00130832-990000000-00128. [PMID: 38814733 DOI: 10.1097/aci.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE OF REVIEW Drug allergy is responsible for a huge burden on public healthcare systems, representing in some instances a threat for patient's life. Diagnosis is complex due to the heterogeneity of clinical phenotypes and mechanisms involved, the limitations of in vitro tests, and the associated risk to in vivo tests. Predictive models, including those using recent advances in artificial intelligence, may circumvent these drawbacks, leading to an appropriate classification of patients and improving their management in clinical settings. RECENT FINDINGS Scores and predictive models to assess drug allergy development, including patient risk stratification, are scarce and usually apply logistic regression analysis. Over recent years, different methods encompassed under the general umbrella of artificial intelligence, including machine and deep learning, and artificial neural networks, are emerging as powerful tools to provide reliable and optimal models for clinical diagnosis, prediction, and precision medicine in different types of drug allergy. SUMMARY This review provides general concepts and current evidence supporting the potential utility of predictive models and artificial intelligence branches in drug allergy diagnosis.
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Affiliation(s)
- Rafael Núñez
- Allergy Research Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform
| | - Inmaculada Doña
- Allergy Research Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform
- Allergy Unit, Malaga Regional University Hospital, Malaga
- Inflammatory Diseases Network (RICORS, RD21/0002/0008, Instituto de Salud Carlos III), Málaga, Spain
| | - José Antonio Cornejo-García
- Allergy Research Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform
- Allergy Unit, Malaga Regional University Hospital, Malaga
- Inflammatory Diseases Network (RICORS, RD21/0002/0008, Instituto de Salud Carlos III), Málaga, Spain
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2
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Pesqué D, Aerts O, Bizjak M, Gonçalo M, Dugonik A, Simon D, Ljubojević-Hadzavdić S, Malinauskiene L, Wilkinson M, Czarnecka-Operacz M, Krecisz B, John SM, Balato A, Ayala F, Rustemeyer T, Giménez-Arnau AM. Differential diagnosis of contact dermatitis: A practical-approach review by the EADV Task Force on contact dermatitis. J Eur Acad Dermatol Venereol 2024. [PMID: 38713001 DOI: 10.1111/jdv.20052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/15/2024] [Indexed: 05/08/2024]
Abstract
The diagnosis of eczema ('dermatitis') is mostly clinical and depends on the clinical history and exploratory objective findings (primary lesions, patterns). Contact dermatitis remains as an important condition in the group of eczematous disorders, with important socioeconomic and occupational relevance. Although irritant and allergic contact dermatitis have a different pathogenesis, both are characterized by a rather typical morphology, are triggered by external factors and tend to occur primarily in the area of contact with the exogenous agent. In addition, allergic and irritant dermatitis may also co-exist. The importance of diagnosing contact dermatitis, especially when allergic in nature, is both due to the possibility of avoiding the trigger, and due to its role in aggravating other skin conditions. Nevertheless, the heterogeneity of clinical presentations in daily practice may pose an important challenge for the suspicion and correct diagnosis of contact dermatitis. Furthermore, other conditions, with different pathogenesis and treatment, may clinically simulate contact dermatitis. The Task Force aims to conduct a review of the unifying clinical features of contact dermatitis and characterize its main clinical phenotypes, and its simulators, in order to contribute to an early suspicion or recognition of contact dermatitis and enable a correct differential diagnosis.
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Affiliation(s)
- David Pesqué
- Dermatology Department, Hospital del Mar Research Institute, Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA) and Research Group Immunology, University of Antwerp, Antwerp, Belgium
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Aleksandra Dugonik
- Department of Dermatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Dagmar Simon
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Suzana Ljubojević-Hadzavdić
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Laura Malinauskiene
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Vilnius University, Vilnius, Lithuania
| | - Mark Wilkinson
- Leeds Centre for Dermatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | | | - Beata Krecisz
- Collegium Medicum, Jan Kochanowski University Kielce, Kielce, Poland
| | - Swen M John
- Department of Dermatology, Environmental Medicine, Osnabrueck University, Osnabrueck, Germany
| | - Anna Balato
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Ayala
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ana M Giménez-Arnau
- Dermatology Department, Hospital del Mar Research Institute, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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3
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Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management. J Am Acad Dermatol 2024; 90:911-926. [PMID: 37516356 DOI: 10.1016/j.jaad.2023.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 07/31/2023]
Abstract
Drug-induced hypersensitivity syndrome, also known as drug reaction with eosinophilia and systemic symptoms, is a severe cutaneous adverse reaction characterized by an exanthem, fever, and hematologic and visceral organ involvement. The differential diagnosis includes other cutaneous adverse reactions, infections, inflammatory and autoimmune diseases, and neoplastic disorders. Three sets of diagnostic criteria have been proposed; however, consensus is lacking. The cornerstone of management is immediate discontinuation of the suspected drug culprit. Systemic corticosteroids remain first-line therapy, but the literature on steroid-sparing agents is expanding. Longitudinal evaluation for sequelae is recommended. Adjunctive tests for risk stratification and drug culprit identification remain under investigation. Part II of this continuing medical education activity begins by exploring the differential diagnosis and diagnosis of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms and concludes with an evidence-based overview of evaluation and treatment.
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Affiliation(s)
- Brian M Wei
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
| | | | - Abraham M Korman
- Department of Dermatology, The Ohio State University, Columbus, Ohio
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arash Mostaghimi
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan H Noe
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco, California
| | - Jason H Kwah
- Department of Medicine, Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - William Damsky
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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4
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Rebai J, Romdhane HB, Mansour K, Fadhel NB, Lahouel I, Chadly Z, Chaabane A, Fredj NB, Aouam K. Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms (DRESS): Interest of skin tests in cross-reactivity to phenobarbital. Therapie 2024; 79:398-401. [PMID: 37407309 DOI: 10.1016/j.therap.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/11/2023] [Accepted: 06/02/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Jawhar Rebai
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia.
| | - Haifa Ben Romdhane
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Khadija Mansour
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Najah Ben Fadhel
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Ines Lahouel
- Dermatology Department, Fattouma Bourguiba Hospital, University of Medicine, 5019 Monastir, Tunisia
| | - Zohra Chadly
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Amel Chaabane
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Nadia Ben Fredj
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Karim Aouam
- Department of Pharmacology, Faculty de Medicine of Monastir, rue Avicenne, 5019 Monastir, Tunisia
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Brüggen MC, Traidl S, Mitamura Y, Walsh S, French LE, Gulati N, Phillips E, Maverakis E, Ingen-Housz-Oro S. Medical algorithm: Diagnosis and treatment of drug reaction with eosinophilia and systemic symptoms in adult patients. Allergy 2024. [PMID: 38587051 DOI: 10.1111/all.16122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/15/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Marie-Charlotte Brüggen
- Faculty of Medicine, University Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
- ToxiTEN group of the ERN-skin
| | - Stephan Traidl
- Faculty of Medicine, University Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF) Davos, Davos, Switzerland
| | - Sarah Walsh
- ToxiTEN group of the ERN-skin
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Lars E French
- ToxiTEN group of the ERN-skin
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Nicholas Gulati
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, California, USA
| | - Saskia Ingen-Housz-Oro
- ToxiTEN group of the ERN-skin
- Department of Dermatology, Henri Mondor Hospital, Univ Paris Est Créteil EpidermE, Créteil, Paris, France
- Reference center for severe drug reactions TOXIBUL, Créteil, France
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Mathieu A, de Grandmont M, Fernandes CL, Kechichian E. Triggers, clinical manifestations and assessment of paediatric fixed drug eruptions: A systematic review of the literature. Contact Dermatitis 2024; 90:343-349. [PMID: 38234071 DOI: 10.1111/cod.14500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
Fixed drug eruption (FDE) is a cutaneous drug reaction characterised by recurrent skin lesions occurring at the same site after each exposure to a causative agent. There is currently limited evidence in the paediatric population. The objective of this systematic review is to investigate the clinical features, causative agents and management of paediatric FDE. A systematic search of the English and French literature on paediatric FDE was conducted using the Medline and Embase databases. After full-text article review, 92 articles were included, representing a total of 233 patients. Antibiotics were the most frequent triggering agents, mainly sulfonamides (65.0% of antibiotics). Systemic symptoms were rare, and most patients only received supportive therapy. One hundred and six patients (106) performed a test to confirm the causative agent. Of these, 72.6% had oral provocation tests (OPTs) and 28.3% had patch tests. The patient's age, presence of bullous lesions and mucosal lesions were similar between tested and untested patients. It did not seem to influence the decision to perform OPTs. Paediatric FDE is a non-severe skin drug reaction. Antibiotics were the most reported triggering agents. Drug testing, including oral provocation test, was safely performed in the paediatric population.
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Affiliation(s)
- Audrey Mathieu
- Department of Dermatology, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Dermatology, Université Laval, Québec, Québec, Canada
| | | | | | - Elio Kechichian
- Department of Dermatology, Université de Sherbrooke, Sherbrooke, Québec, Canada
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7
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Bavbek S, Kepil Özdemir S, Bonadonna P, Atanaskovic-Markovic M, Barbaud A, Brockow K, Laguna Martinez J, Nakonechna A, Pagani M, Arcolacı A, Lombardo C, Torres MJ. Hypersensitivity reactions to proton pump inhibitors. An EAACI position paper. Allergy 2024; 79:552-564. [PMID: 38013608 DOI: 10.1111/all.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Proton pump inhibitors (PPIs) are invaluable therapeutic options in a variety of dyspeptic diseases. In addition to their well-known risk profile, PPI consumption is related to food and environmental allergies, dysbiosis, osteoporosis, as well as immediate and delayed hypersensitivity reactions (HSRs). The latter, although a rare event, around 1%-3%, due to the extraordinarily high rate of prescription and consumption of PPIs are related to a substantial risk. In this Position Paper, we provide clinicians with practical evidence-based recommendations for the diagnosis and management of HSRs to PPIs. Furthermore, the unmet needs proposed in the document aim to stimulate more in-depth investigations in the topic.
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Affiliation(s)
- Sevim Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Seçil Kepil Özdemir
- Department of Chest Diseases, Allergy and Immunology Unit, İzmir Faculty of Medicine, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | | | - Marina Atanaskovic-Markovic
- Department of Allergology and Pulmonology, Faculty of Medicine, University of Belgrade, University Children's Hospital, Belgrade, Serbia
| | - Annick Barbaud
- Département de dermatologie et allergologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Jose Laguna Martinez
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain
| | - Alla Nakonechna
- Allergy and Clinical Immunology Department, University of Liverpool, Royal Preston Hospital, Lancashire Teaching Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Mauro Pagani
- Medicine Department, Medicine Ward Mantova Hospital, ASST di Mantova, Mantova, Italy
| | | | - Carla Lombardo
- Division of Dermatology and Allergy, APSS - Trento Hospital, Trento, Italy
| | - Maria J Torres
- Allergy Unit, Regional University Hospital of Malaga, IBIMA-UMA-ARADyAL, Malaga, Spain
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Barbaud A, Garvey LH, Torres M, Laguna JJ, Arcolaci A, Bonadonna P, Scherer Hofmeier K, Chiriac AM, Cernadas J, Caubet JC, Brockow K. EAACI/ENDA position paper on drug provocation testing. Allergy 2024; 79:565-579. [PMID: 38155501 DOI: 10.1111/all.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
In drug hypersensitivity, drug provocation testing (DPT), also called drug challenge, is the gold standard for investigation. In recent years, risk stratification has become an important tool for adjusting the diagnostic strategy to the perceived risk, whilst still maintaining a high level of safety for the patient. Skin tests are recommended before DPT but may be omitted in low-risk patients. The task force suggests a strict definition of such low-risk patients in children and adults. Based on experience and evidence from studies of allergy to beta-lactam antibiotics, an algorithm on how to adjust DPT to the risk, and when to omit skin tests before DPT, is presented. For other antibiotics, non-steroidal anti-inflammatory drugs and other drugs, skin tests are poorly validated and DPT is frequently necessary. We recommend performing DPT with chemotherapeutics and biologicals to avoid unnecessary desensitization procedures and DPT with skin tests negative contrast media. We suggest DPT with anesthetics only in highly specialized centers. Specifics of DPT to proton pump inhibitors, anticonvulsants and corticosteroids are discussed. This position paper provides general recommendations and guidance on optimizing use of DPT, whilst balancing benefits with patient safety and optimizing the use of the limited available resources.
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Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Tenon, Service de dermatologie et allergologie, Paris, France
| | - Lene Heise Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Torres
- Allergy Unit, Regional University Hospital of Malaga-IBIMA-UMA-ARADyAL, Malaga, Spain
| | - Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, ARADyAL, REI, Madrid, Spain
| | - Alessandra Arcolaci
- Immunology Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Patrizia Bonadonna
- Allergy Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Kathrin Scherer Hofmeier
- Allergy and Dermatology, Cantonal Hospital Aarau, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Anca Mirela Chiriac
- Allergy Unit, University Hospital of Montpellier and IDESP, UMR UA11, Univ. Montpellier - INSERM, Montpellier, France
| | - Josefina Cernadas
- Hospital Lusíadas, Porto, Portugal
- Centro Hospitalar Universitário H. S. João, Porto, Portugal
| | - Jean Christoph Caubet
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine and Health, Munich, Germany
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Traineau H, Milpied B, Soria A, Assier H, Tetart F, Bernier C, Le Bouëdec MCF, Gener G, Kurihara F, Bauvin O, Delauney J, Amsler E, Bara C, Pelletier F, Valois A, Castelain F, de Risi Pugliese T, Hamelin A, Barbaud A. In Situ Patch Test and Repeated Open Application Test for Fixed Drug Eruption: A Multicenter Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:460-468. [PMID: 37863314 DOI: 10.1016/j.jaip.2023.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Few studies have evaluated allergy workup in fixed drug eruption (FDE) in a large population. OBJECTIVE To evaluate the sensitivity of a standardized allergy workup for diagnosing the cause of FDE, with a focus on in situ repeated open application tests (ROATs). METHODS In a retrospective multicenter study, we analyzed the practice of conducting a complete allergy workup for the etiological diagnosis of FDE. It consisted of 3 steps: in situ patch tests (PTs) for all cases except pure mucosal involvement, followed by in situ ROAT if in situ PT results were negative, and finally a drug challenge (DC). The in situ ROAT involved daily application of the suspected drug on a previously affected FDE site for 7 days. RESULTS Of 98 suspected FDE cases, 61 patients (median age 61 y; male-to-female ratio 1.8) with a complete allergy workup were included. In 4 cases, even the DC yielded negative results. Among the remaining 57 patients with a positive workup, implicated drugs included paracetamol (12 cases), β-lactams (11 cases), imidazoles (9 cases, including 5 with metronidazole), nonsteroidal anti-inflammatory drugs (8 cases), iodinated contrast media (4 cases), cotrimoxazole (3 cases), and various other drugs in 10 patients. The diagnosis was confirmed by in situ PT in 17 of 54 cases (31.5%), in situ ROAT in 14 of 40 cases (35%) (with 4 cases showing remote reactivation of FDE sites), and DC in 26 cases. CONCLUSIONS The sequential allergy workup involving successively in situ PT, in situ ROAT, and DC is a reliable and safe method for diagnosing the cause of FDE. In situ tests exhibited a sensitivity of over 50%.
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Affiliation(s)
- Hélène Traineau
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brigitte Milpied
- Centre hospitalo-universitaire (CHU) de Bordeaux, Dermatology department, Saint André hospital, Bordeaux, France
| | - Angèle Soria
- Cimi-Paris Inserm 1135, AP-HP, Sorbonne University, Hôpital Tenon, Dermatology and allergology department, Paris, France
| | - Haudrey Assier
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | | | | | | | - Gwendeline Gener
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | - Flore Kurihara
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Juliette Delauney
- CHU d'Angers, Dermatology department, Centre hospitalier de Cholet, Angers, France
| | - Emmanuelle Amsler
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Corina Bara
- Dermatology department, Centre hospitalier du Mans, Le Mans, France
| | | | - Aude Valois
- Dermatology department, Hôpital d'instruction des armées Sainte Anne, Toulon, France
| | | | - Tullia de Risi Pugliese
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Aurore Hamelin
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Annick Barbaud
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
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10
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Massoumi S, Rizvi Z, Cázares U, Maibach H. Overcoming False-Negative Patch Tests: A Systematic Literature Review. Dermatitis 2024. [PMID: 38181174 DOI: 10.1089/derm.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Exogenous allergens, found in cosmetic products, jewelry items, antiseptics and antibacterials, plants, and solvents, can cause clinical allergic contact dermatitis (ACD). To help identify and discern which allergen is causing ACD, clinicians use patch tests, but they can yield false-negative results at times. Examining potential reasoning for false negatives is particularly helpful when a patient's history and physical examination strongly suggest ACD, and the patch test is negative. A strong history and physical presentation suggestive of ACD warrants additional patch testing or other methods to verify a false-negative patch test result. We conducted a literature review to compile various reasonings and solutions for false-negative patch tests in suspected ACD patients. Utilizing EMBASE, Scopus, PubMed, and Google Scholars, 49 articles were included by using search terms such as "False negative patch test" or "False-negative patch test" and "allergic contact dermatitis," or "ACD." Common factors that led to false-negative patch test results include low allergen concentration, inadequate percutaneous penetration, technique error, immunosuppressive therapy, and ultraviolet exposure. Potential solutions include using different vehicles, concentration, increasing reading time, repeating the patch test, intradermal testing, and repeat open application testing. If a false-negative patch test is suspected, then intradermal testing can be administered to ensure the specificity of the patch test result. Considering the main contributing factors and solutions to false-negative patch tests, clinicians can accurately diagnose ACD and administer proper treatment plans.
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Affiliation(s)
- Shayan Massoumi
- From the Department of Dermatology, California University of Science and Medicine, Colton, California, USA
| | - Zehra Rizvi
- From the Department of Dermatology, California University of Science and Medicine, Colton, California, USA
| | - Ulysses Cázares
- School of Medicine, University of California Riverside, Riverside, California, USA
| | - Howard Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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11
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Pires Pereira H, Coutinho IA, Carrapatoso I, Todo-Bom A. Drug Rash with Eosinophilia and Systemic Symptoms Syndrome Caused by Itraconazole in a 17-Year-Old Girl. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:143-146. [PMID: 37729075 DOI: 10.1089/ped.2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced hypersensitivity reaction. We report a case of DRESS syndrome in a 17-year-old female caused by itraconazole, confirmed by patch testing, that required treatment with both corticotherapy and cyclosporine. Our case highlights the importance of clinical suspicion of this syndrome in pediatric age and the novelty of an antifungal drug being identified as the culprit.
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Affiliation(s)
- Helena Pires Pereira
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Iolanda Alen Coutinho
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Isabel Carrapatoso
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Ana Todo-Bom
- Allergy and Clinical Immunology Department, Coimbra University Hospital Center, Coimbra, Portugal
- Allergy and Clinical Immunology Department, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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12
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Ben Romdhane H, Fadhel NB, Chadli Z, Chaabane A, Benzarti W, Fredj NB, Aouam K. Drug reaction with eosinophilia and systemic symptoms in a paediatric population: Interest of skin tests. Contact Dermatitis 2023; 89:488-495. [PMID: 37731315 DOI: 10.1111/cod.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/03/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction. It is uncommon in the paediatric population and can be difficult to diagnose as its initial symptoms may mimic a viral infection. OBJECTIVE To analyse the features of paediatric DRESS and to evaluate the interest of skin tests in identifying the causative drugs. METHODS It is a retrospective analysis (2004-2021) of DRESS cases diagnosed in paediatric patients. The DRESS diagnosis was defined using the RegiSCAR scoring. The skin tests were performed according to the ENDA recommendations. RESULTS We included 19 cases of DRESS occurred in 18 patients. Common clinical symptoms were exanthema and fever in 94.7% of cases each. The most commonly affected organ was the liver (84.2%). Among the implicated drugs, 16 were tested and skin tests were positive in 75%. To assess cross-reactivity and co-sensitization, skin tests with related and/or co-administered drugs were performed in eight patients. Among them, only one child had positive results. CONCLUSION Early diagnosis of DRESS and discontinuation of the incriminated drug might reduce the incidence of mortality in the paediatric population. Skin tests could be a safe and useful tool to identify the causative drug and assess cross-reactivity.
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Affiliation(s)
- Haifa Ben Romdhane
- Faculty of Medicine, Department of Pharmacology, EPS Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Najah Ben Fadhel
- Faculty of Medicine, Department of Pharmacology, EPS Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Zohra Chadli
- Faculty of Medicine, Department of Pharmacology, EPS Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Amel Chaabane
- Faculty of Medicine, Department of Pharmacology, EPS Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Wiem Benzarti
- Faculty of Medicine, Department of Pharmacology, EPS Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Nadia Ben Fredj
- Faculty of Medicine, Department of Pharmacology, EPS Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Karim Aouam
- Faculty of Medicine, Department of Pharmacology, EPS Fattouma Bourguiba, University of Monastir, Monastir, Tunisia
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13
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Toulemonde É, Lannoy D, Gautier S, Stéfanski M, Miaux C, Azib-Meftah S, Staumont-Sallé D, Dezoteux F. Skin Testing and Drug Provocation Tests Should Be Performed in the Context of Drug Reaction with Eosinophilia and Systemic Symptoms: A Cohort Study. Dermatitis 2023. [PMID: 37972110 DOI: 10.1089/derm.2023.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Élise Toulemonde
- Service de dermatologie CHU Lille Université de Lille Lille France
| | - Damien Lannoy
- CHU Lille Institut de Pharmacie Lille France
- GRITA Groupe de Recherche sur les Formes Injectables et les Technologies Associées Université de Lille Lille France
| | - Sophie Gautier
- Centre régional de pharmacovigilance CHU Lille Université de Lille Lille France
| | - Marion Stéfanski
- Service de dermatologie CHU Lille Université de Lille Lille France
| | - Céline Miaux
- Service de dermatologie CHU Lille Université de Lille Lille France
| | | | - Delphine Staumont-Sallé
- Service de dermatologie CHU Lille Université de Lille Lille France
- U1286 Inserm INFINITE Institute for Translational Research in Inflammation Lille France
| | - Frédéric Dezoteux
- Service de dermatologie CHU Lille Université de Lille Lille France
- U1286 Inserm INFINITE Institute for Translational Research in Inflammation Lille France
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14
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Rodríguez-Pérez R, de las Vecillas L, Cabañas R, Bellón T. Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions. Int J Mol Sci 2023; 24:12577. [PMID: 37628756 PMCID: PMC10454098 DOI: 10.3390/ijms241612577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Drug hypersensitivity reactions are a serious concern in clinical practice because they can be severe and result in lifelong sequelae. An accurate diagnosis and identification of the culprit drug is essential to prevent future reactions as well as for the identification of safe treatment alternatives. Nonetheless, the diagnosis can be challenging. In vivo and in vitro tests can be helpful, although none are conclusive; therefore, the tests are not usually performed in isolation but as part of a diagnostic algorithm. In addition, some in vitro tests are only available in research laboratories, and standardization has not been fully accomplished. Collaborating research is needed to improve drug hypersensitivity reaction diagnosis. In this review, we update the current available in vivo and in vitro tools with their pros and cons and propose an algorithm to integrate them into clinical practice.
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Affiliation(s)
- Rosa Rodríguez-Pérez
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
| | - Leticia de las Vecillas
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
- Allergy Department, La Paz University Hospital, Paseo Castellana 261, 28046 Madrid, Spain
- PIELenRed Consortium, 28046 Madrid, Spain
| | - Rosario Cabañas
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
- Allergy Department, La Paz University Hospital, Paseo Castellana 261, 28046 Madrid, Spain
- PIELenRed Consortium, 28046 Madrid, Spain
- Center for Biomedical Research Network on Rare Diseases (CIBERER U754), 28046 Madrid, Spain
| | - Teresa Bellón
- Institute for Health Research Hospital Universitario La Paz (IdiPAZ), Paseo Castellana 261, 28046 Madrid, Spain; (L.d.l.V.); (R.C.); (T.B.)
- PIELenRed Consortium, 28046 Madrid, Spain
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15
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Parisi R, Shah H, Navarini AA, Muehleisen B, Ziv M, Shear NH, Dodiuk-Gad RP. Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management. Am J Clin Dermatol 2023:10.1007/s40257-023-00779-3. [PMID: 37156992 PMCID: PMC10166469 DOI: 10.1007/s40257-023-00779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/10/2023]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.
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Affiliation(s)
- Rose Parisi
- Albany Medical College, Albany, New York, NY, USA
| | - Hemali Shah
- Albany Medical College, Albany, New York, NY, USA
| | - Alexander A Navarini
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Beda Muehleisen
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Roni P Dodiuk-Gad
- Department of Dermatology, Emek Medical Center, Afula, Israel.
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada.
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, 3525433, Israel.
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16
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Ashifha S, Vijayashree J, Vudayana K, Chintada D, P P, G P, Unnikrishnan P. A Study of Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Andhra Pradesh, India. Cureus 2023; 15:e37596. [PMID: 37197134 PMCID: PMC10184741 DOI: 10.7759/cureus.37596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Practically all physicians encounter a diverse range of suspected cutaneous adverse drug reactions (CADRs) in their daily clinical practice. The skin and mucosa are the most often encountered areas for the early presentation of numerous adverse drug reactions. Cutaneous adverse drug reactions are classified as benign or severe. The clinical manifestations of drug eruptions can range from mild maculopapular exanthema to severe cutaneous adverse drug reactions (SCARs). OBJECTIVE To determine the varied clinical and morphological presentations of CADRs and to identify the culprit drug and common drugs causing CADRs. MATERIALS AND METHODS Patients with clinical features suspected of CADRs presenting to the outpatient department (OPD) of dermatology, venereology, and leprosy (DVL) between December 2021 to November 2022 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, were considered for the study. This was a cross-sectional, observational study. The patient's clinical history was taken in detail. This included chief complaints (symptoms, site of onset, duration, drug history, latency time between drug administration and the appearance of cutaneous lesions), family history, associated diseases, the morphology of lesions, and mucosal examination. Upon drug discontinuation, improvement in cutaneous lesions and systemic features were noted. A complete general examination, systemic examination, dermatological tests, and mucosal examination were performed. RESULTS A total of 102 patients were involved in the study, of whom 55 were males and 47 were females. The male-to-female ratio was 1.17:1, with a slight male majority. The most common age group was 31 to 40 years for both males and females. Itching was the predominant complaint in 56 patients (54.9%). The mean latency period was shortest in urticaria (2.13+/- 0.99 hours) and longest in lichenoid drug eruption (4.33+/- 3.93 months). Most patients developed symptoms after a week of taking the drug (53.92%). A history of similar complaints was present in 38.23% of patients. Analgesics and antipyretics (39.2%) were the most common culprit drugs followed by antimicrobials (29.4%). Among analgesics and antipyretics, aceclofenac (24.5%) was the commonest culprit drug. Benign CADRs were observed in 89 patients (87.25%), and severe cutaneous adverse reactions (SCARs) were observed in 13 patients (12.74%). The common CADRs presented were drug-induced exanthem (27.4%). Imatinib-induced psoriasis vulgaris and lithium-induced scalp psoriasis were observed in one patient each. Severe cutaneous adverse reactions were observed in 13 patients (12.74%). Anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimicrobials were the culprit drugs for SCARs. Eosinophilia was present in three patients, deranged liver enzymes was present in nine patients, a deranged renal profile was present in seven patients, and death occurred in one patient with toxic epidermal necrolysis (TEN) of SCARs. CONCLUSION Before prescribing any drug to a patient, a detailed drug history and family history of drug reactions need to be obtained. Patients should be advised to avoid over-the-counter usage of medications and self-administration of drugs. If adverse drug reactions occur, it is advised to avoid readministration of the culprit drug. Drug cards must be prepared and given to the patient, mentioning the culprit drug as well as the cross-reacting drugs.
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Affiliation(s)
- Shaik Ashifha
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Jami Vijayashree
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Kirankanth Vudayana
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Dilipchandra Chintada
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Pavani P
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Pallavi G
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Pooja Unnikrishnan
- Dermatology, Venereology and Leprosy, Great Eastern Medical School and Hospital, Srikakulam, IND
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17
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Ingen-Housz-Oro S, Schmidt V, Ameri MM, Abe R, Brassard A, Mostaghimi A, Paller AS, Romano A, Didona B, Kaffenberger BH, Ben Said B, Thong BYH, Ramsay B, Brezinova E, Milpied B, Mortz CG, Chu CY, Sotozono C, Gueudry J, Fortune DG, Dridi SM, Tartar D, Do-Pham G, Gabison E, Phillips EJ, Lewis F, Salavastru C, Horvath B, Dart J, Setterfield J, Newman J, Schulz JT, Delcampe A, Brockow K, Seminario-Vidal L, Jörg L, Watson MP, Gonçalo M, Lucas M, Torres M, Noe MH, Hama N, Shear NH, O’Reilly P, Wolkenstein P, Romanelli P, Dodiuk-Gad RP, Micheletti RG, Tiplica GS, Sheridan R, Rauz S, Ahmad S, Chua SL, Flynn TH, Pichler W, Le ST, Maverakis E, Walsh S, French LE, Brüggen MC. Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus. Orphanet J Rare Dis 2023; 18:33. [PMID: 36814255 PMCID: PMC9945700 DOI: 10.1186/s13023-023-02631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of management of these sequelae is lacking. OBJECTIVES We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae. METHODS Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method. RESULTS Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded. CONCLUSIONS Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.
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Affiliation(s)
- S. Ingen-Housz-Oro
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.410511.00000 0001 2149 7878EpiDermE, Université Paris Est Créteil, Créteil, France
| | - V. Schmidt
- grid.410567.1University Hospital Basel, Basel, Switzerland ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - M. M. Ameri
- grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - R. Abe
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - A. Brassard
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - A. Mostaghimi
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - A. S. Paller
- grid.16753.360000 0001 2299 3507Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - A. Romano
- grid.419843.30000 0001 1250 7659Oasi Research Institute-IRCCS, Troina, Italy
| | - B. Didona
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.419457.a0000 0004 1758 0179Rare Disease Unit, I Dermatology Division, Istituto Dermopatico Dell’Immacolata, IRCCS, Rome, Italy
| | - B. H. Kaffenberger
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412332.50000 0001 1545 0811The Ohio State University Wexner Medical Center Division of Dermatology, Upper Arlington, OH USA
| | - B. Ben Said
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,Department of Dermatology, CHU Edouard Herriot, Lyon, France
| | - B. Y. H. Thong
- grid.240988.f0000 0001 0298 8161Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - B. Ramsay
- grid.415522.50000 0004 0617 6840Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - E. Brezinova
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.10267.320000 0001 2194 0956First Department of Dermatovenereology, Masaryk University Faculty of Medicine, St. Ann’s Faculty Hospital in Brno, Brno, Czech Republic
| | - B. Milpied
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.412041.20000 0001 2106 639XDepartment of Adult and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France
| | - C. G. Mortz
- grid.7143.10000 0004 0512 5013Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - C. Y. Chu
- grid.19188.390000 0004 0546 0241Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002 Taiwan
| | - C. Sotozono
- grid.272458.e0000 0001 0667 4960Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Hirokoji-Agaru, Kawaramach-Dori, Kamigyo-Ku, Kyoto, 602-0841 Japan
| | - J. Gueudry
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France
| | - D. G. Fortune
- grid.10049.3c0000 0004 1936 9692Department of Psychology, University of Limerick, Limerick, Ireland
| | - S. M. Dridi
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.416670.2MICORALIS Laboratory, Department of Periodontology, Faculty of Dentistry, Côte d’Azur University, Saint Roch Hospital, Nice, France
| | - D. Tartar
- grid.27860.3b0000 0004 1936 9684Department of Dermatology, University of California Davis, Sacramento, CA USA
| | - G. Do-Pham
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.414145.10000 0004 1765 2136Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - E. Gabison
- grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - E. J. Phillips
- grid.1025.60000 0004 0436 6763Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA Australia ,grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - F. Lewis
- grid.425213.3St John’s Institute of Dermatology, Guy’s and St Thomas’ Hospital, London, UK
| | - C. Salavastru
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Department of Paediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - B. Horvath
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.4830.f0000 0004 0407 1981Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - J. Dart
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - J. Setterfield
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.420545.20000 0004 0489 3985Department of Oral Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - J. Newman
- grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - J. T. Schulz
- grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, 02114 USA
| | - A. Delcampe
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France ,grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France ,grid.411119.d0000 0000 8588 831XDepartment of Ophthalmology, CHU Bichat-Claude Bernard, Paris, France
| | - K. Brockow
- grid.6936.a0000000123222966Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - L. Seminario-Vidal
- grid.170693.a0000 0001 2353 285XDepartment of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL USA
| | - L. Jörg
- grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M. P. Watson
- grid.439257.e0000 0000 8726 5837Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - M. Gonçalo
- grid.28911.330000000106861985Department of Dermatology, Coimbra University Hospital Center, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M. Lucas
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA 6009 Australia ,grid.3521.50000 0004 0437 5942Department of Immunology, Sir Charles Gairdner Hospital, Pathwest Laboratory Medicine, Perth, WA 6009 Australia
| | - M. Torres
- grid.452525.1Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - M. H. Noe
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - N. Hama
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N. H. Shear
- grid.17063.330000 0001 2157 2938Department of Dermatology, University of Toronto, Toronto, ON Canada ,grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - P. O’Reilly
- grid.10049.3c0000 0004 1936 9692Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - P. Wolkenstein
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - P. Romanelli
- grid.26790.3a0000 0004 1936 8606Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL USA
| | - R. P. Dodiuk-Gad
- grid.6451.60000000121102151Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, Canada
| | - R. G. Micheletti
- grid.25879.310000 0004 1936 8972Department of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - G. S. Tiplica
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,2Nd Department of Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - R. Sheridan
- grid.415829.30000 0004 0449 5362Burn Service, Boston Shriners Hospital for Children, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Surgery, Harvard Medical School, Boston, MA USA
| | - S. Rauz
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - S. Ahmad
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - S. L. Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412563.70000 0004 0376 6589Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T. H. Flynn
- grid.460892.10000 0004 0389 5639Ophthalmology, Bon Secours Hospital, Cork, Ireland
| | - W. Pichler
- grid.482939.dADR-AC GmbH, Bern, Switzerland
| | - S. T. Le
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - E. Maverakis
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - S. Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - L. E. French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.411095.80000 0004 0477 2585Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany ,grid.26790.3a0000 0004 1936 8606Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL USA
| | - M. C. Brüggen
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
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18
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Novack DE, Braskett M, Worswick SD, Adler BL. Drug patch testing in Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review. Ann Allergy Asthma Immunol 2023; 130:628-636. [PMID: 36649833 DOI: 10.1016/j.anai.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND The data on patch testing (PT) to identify culprit medications in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are limited to scattered case reports and small case series, without analysis of overall trends to inform clinicians of its utility, methodology, and safety. OBJECTIVE To conduct a systematic review of the practice of PT in SJS/TEN, quantify the positivity rate of common drug classes, and assess safety during testing. METHODS PubMed was searched from inception to 2021. Search terms included "patch testing" AND "SJS" OR "TEN" OR "Stevens-Johnson syndrome" OR "toxic epidermal necrolysis" OR "Lyell's syndrome." RESULTS There were 58 articles that met the inclusion criteria. In total, 82 patients underwent patch testing for SJS/TEN, resulting in 104 positive reactions to 49 unique medications. Antiepileptic drugs were responsible for 48.1% of the positive reactions; antibiotics, 28.8%; and nonsteroidal anti-inflammatory drugs, 6.7%. The positivity rates of antiepileptics, antibiotics, and nonsteroidal anti-inflammatory drugs were 33.1%, 13.1%, and 21.9%, respectively. When accounting for suspected causality, these rates increased to 54.3%, 78.4%, and 54.5%, respectively. Three patients (3.7%), 2 of whom had human immunodeficiency virus infection and active tuberculosis, experienced systemic reactions during PT, which required only conservative treatment. CONCLUSION Published reports suggest that PT in SJS/TEN is useful and safe. Antiepileptic drugs have been tested most frequently and found to have the highest positivity rate. There is a critical need for large-scale studies with standardized methodology to obtain reproducible data on PT in SJS/TEN.
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Affiliation(s)
| | - Melinda Braskett
- Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Scott D Worswick
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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19
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Roux C, Ben Said B, Milpied B, Bernier C, Staumont-Sallé D, Dezoteux F, Soria A, Barbaud A, Valeyrie-Allanore L, Tétart F, Bellon N, Lebrun-Vignes B, Gener G, Paul M, Ingen-Housz-Oro S, Assier H. Skin Testing and Drug Provocation Tests in Epidermal Necrolysis: A French Experience. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3252-3261.e2. [PMID: 35870724 DOI: 10.1016/j.jaip.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are limited data on the use of skin testing, other than patch testing, and challenges in the evaluation of epidermal necrolysis (EN), including Stevens-Johnson syndrome and toxic epidermal necrolysis. OBJECTIVE To report a French multicenter experience in skin testing and challenges in EN, and investigate the factors associated with tests' positivity. METHODS All patients who were evaluated by patch tests (PTs), skin prick tests, intradermal tests (IDTs), or drug provocation tests (DPTs) for EN between 2010 and 2020 were retrospectively included through 2 French drug reaction networks. RESULTS In total, 113 patients were included from 8 centers. Median (interquartile range) time from EN to hypersensitivity workup was 7.9 months (5.1-15 months). All patients had PTs, 17 (15%) had skin prick tests or IDTs with delayed readings and 32 (28.3%) had DPTs. One mild reaction occurred after a DPT. Overall, 22 patients (19.5%) had positive PTs, and the only factors associated with positivity were Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN) score and drug class. Only 1 IDT was positive but considered irrelevant. The DPTs were never performed to prove responsibility of a highly suspected drug but were used to confirm current tolerance of needed medications. CONCLUSIONS Allergological workup in EN, performed by specialists involved in EN, seems safe. Skin tests, although of limited sensitivity, can be helpful for considering the reintroduction of essential drugs according to a benefit-to-risk decision. We propose an algorithm for approaching hypersensitivity testing in patients with EN, to be adapted to each patient.
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Affiliation(s)
- Camille Roux
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Benoit Ben Said
- Department of Allergy and Clinical Immunology, Edouard Herriot Hospital, HCL, Claude Bernard Lyon 1 University, Lyon, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France
| | - Brigitte Milpied
- Department of Allergy and Clinical Immunology, Edouard Herriot Hospital, HCL, Claude Bernard Lyon 1 University, Lyon, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; Department of Dermatology, National Reference Center for Rare Skin Diseases, University of Bordeaux, Bordeaux, France
| | - Claire Bernier
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Nantes University Hospital, Nantes, France
| | - Delphine Staumont-Sallé
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Lille University Hospital, Lille, France
| | - Frédéric Dezoteux
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Lille University Hospital, Lille, France
| | - Angèle Soria
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology and Allergy, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Annick Barbaud
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology and Allergy, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Laurence Valeyrie-Allanore
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Private Practice, Saint-Mandé, France
| | - Florence Tétart
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Rouen University Hospital, Normandie University, Rouen, France
| | - Nathalia Bellon
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Dermatology, Necker Hospital, AP-HP, Paris, France
| | - Bénédicte Lebrun-Vignes
- French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Department of Pharmacology, Pharmacovigilance Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France; Paris Est Créteil University, EpiDermE, Créteil, France
| | - Gwendeline Gener
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Muriel Paul
- Department of Hospital Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France; French Investigators for Skin Adverse Reactions to Drugs (FISARD) Group, Paris, France; Paris Est Créteil University, EpiDermE, Créteil, France
| | - Haudrey Assier
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France; Department of Allergy and Clinical Immunology, Edouard Herriot Hospital, HCL, Claude Bernard Lyon 1 University, Lyon, France; Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions (TOXIBUL), Créteil, France.
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20
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van der Valk H, Pleijhuis RG, Voorbij-Vierstra CL, Schuttelaar MLA. Case report: Recall dermatitis at patch-test sites after oral provocation with mesalazine. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3323-3324.e1. [PMID: 36184024 DOI: 10.1016/j.jaip.2022.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/21/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Hester van der Valk
- Department of Internal Medicine and Allergology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Rick G Pleijhuis
- Department of Internal Medicine and Allergology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
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21
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Management of Drug-Induced Epidermal Necrolysis (DEN) in Pediatric Patients: Moving from Drug-Induced Stevens-Johnson Syndrome, Overlap and Toxic Epidermal Necrolysis to a Single Unifying Diagnosis of DEN. Paediatr Drugs 2022; 24:307-319. [PMID: 35676614 DOI: 10.1007/s40272-022-00515-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
Pediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threating blistering diseases triggered by medications that affect the skin and mucosae. Drug-induced epidermal necrolysis is a better term for medication-triggered cases because there is a spectrum of disease severity that otherwise is divided into the separate entities of SJS, overlap SJS/TEN, and TEN. This manuscript reviews the management of drug-induced epidermal necrolysis (DEN), including diagnosis, investigations to exclude differential diagnoses, and treatment. Diagnosis of DEN relies on clinical features and a detailed medication history. The primary differential diagnosis is reactive infectious mucocutaneous eruption, which can be clinically distinguished by its disproportionate mucous membrane involvement relative to (sparse or absent) skin lesions. Identification and discontinuation of culprit medications is the mainstay of treatment of DEN. Early initiation of immunomodulatory therapy may prevent progression, reducing maximal disease severity and the risk of sequelae. A checklist approach to detailed management of DEN is proposed.
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22
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Kechichian E, Weill A, Ingen-Housz-Oro S, Assier H. Cimetidine and Racecadotril : Unusual Culprit Drugs of a Severe Cutaneous Adverse Reaction. Contact Dermatitis 2022; 87:451-452. [PMID: 35715974 DOI: 10.1111/cod.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Elio Kechichian
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Amandine Weill
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,Centre de référence dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,Centre de référence dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Univ Paris Est Créteil EpidermE, Créteil, France
| | - Haudrey Assier
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,Centre de référence dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France
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23
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Barbaud A, Romano A. Skin Testing Approaches for Immediate and Delayed Hypersensitivity Reactions. Immunol Allergy Clin North Am 2022; 42:307-322. [DOI: 10.1016/j.iac.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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