1
|
Bettuzzi T, Sanchez-Pena P, Lebrun-Vignes B. Cutaneous adverse drug reactions. Therapie 2024; 79:239-270. [PMID: 37980248 DOI: 10.1016/j.therap.2023.09.011] [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: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 11/20/2023]
Abstract
Cutaneous adverse drug reactions (ADRs) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Maculopapular exanthema and urticaria are the most common types of cutaneous ADR. Serious cutaneous ADRs, which may cause permanent sequelae or have fatal outcome, may represent 2% of all cutaneous ADR and must be quickly identified to guide their management. These serious reactions include bullous manifestations (epidermal necrolysis i.e. Stevens-Johnson syndrome and toxic epidermal necrolysis), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Some risk factors for developing cutaneous ADRs have been identified, including immunosuppression, autoimmunity or genetic variants. All drugs can cause cutaneous ADRs, the most commonly implicated being antibiotics (especially aminopenicillins and sulfonamides), anticonvulsants, allopurinol, antineoplastic drugs, non-steroidal anti-inflammatory drugs and iodinated contrast media. Pathophysiology is related to immediate or delayed "idiosyncratic" immunologic mechanisms, i.e., usually not related to dose, and pharmacologic/toxic mechanisms, commonly dose-dependent and/or time-dependent. If an immuno-allergic mechanism is suspected, allergological explorations (including epicutaneous patch testing and/or intradermal test) are often possible to clarify drug causality, however these have a variable sensitivity according to the drug and to the ADR type. No in vivo or in vitro test can consistently confirm the drug causality. To determine the origin of a rash, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis (especially infectious etiologies) is required, completed with a literature search. Reporting to pharmacovigilance system is therefore essential both to analyze drug causality at individual level, and to contribute to knowledge of the drug at population level, especially for serious cutaneous ADRs or in cases involving newly marketed drugs.
Collapse
Affiliation(s)
- Thomas Bettuzzi
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; EpiDermE, université Paris Est Créteil Val-de-Marne, 94000 Créteil, France
| | - Paola Sanchez-Pena
- Service de pharmacologie médicale, centre régional de pharmacovigilance de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France; Groupe FISARD de la Société française de dermatologie, France
| | - Bénédicte Lebrun-Vignes
- EpiDermE, université Paris Est Créteil Val-de-Marne, 94000 Créteil, France; Groupe FISARD de la Société française de dermatologie, France; Service de pharmacologie médicale, centre régional de pharmacovigilance Pitié-Saint-Antoine, groupe hospitalier AP-HP-Sorbonne université, 75013 Paris, France.
| |
Collapse
|
2
|
Line J, Saville E, Meng X, Naisbitt D. Why drug exposure is frequently associated with T-cell mediated cutaneous hypersensitivity reactions. FRONTIERS IN TOXICOLOGY 2023; 5:1268107. [PMID: 37795379 PMCID: PMC10546197 DOI: 10.3389/ftox.2023.1268107] [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: 07/27/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Cutaneous hypersensitivity reactions represent the most common manifestation of drug allergy seen in the clinic, with 25% of all adverse drug reactions appearing in the skin. The severity of cutaneous eruptions can vastly differ depending on the cellular mechanisms involved from a minor, self-resolving maculopapular rash to major, life-threatening pathologies such as the T-cell mediated bullous eruptions, i.e., Stevens Johnson syndrome/toxic epidermal necrolysis. It remains a significant question as to why these reactions are so frequently associated with the skin and what factors polarise these reactions towards more serious disease states. The barrier function which the skin performs means it is constantly subject to a barrage of danger signals, creating an environment that favors elicitation. Therefore, a critical question is what drives the expansion of cutaneous lymphocyte antigen positive, skin homing, T-cell sub-populations in draining lymph nodes. One answer could be the heterologous immunity hypothesis whereby tissue resident memory T-cells that express T-cell receptors (TCRs) for pathogen derived antigens cross-react with drug antigen. A significant amount of research has been conducted on skin immunity in the context of contact allergy and the role of tissue specific antigen presenting cells in presenting drug antigen to T-cells, but it is unclear how this relates to epitopes derived from circulation. Studies have shown that the skin is a metabolically active organ, capable of generating reactive drug metabolites. However, we know that drug antigens are displayed systemically so what factors permit tolerance in one part of the body, but reactivity in the skin. Most adverse drug reactions are mild, and skin eruptions tend to be visible to the patient, whereas minor organ injury such as transient transaminase elevation is often not apparent. Systemic hypersensitivity reactions tend to have early cutaneous manifestations, the progression of which is halted by early diagnosis and treatment. It is apparent that the preference for cutaneous involvement of drug hypersensitivity reactions is multi-faceted, therefore this review aims to abridge the findings from literature on the current state of the field and provide insight into the cellular and metabolic mechanisms which may contribute to severe cutaneous adverse reactions.
Collapse
Affiliation(s)
| | | | | | - Dean Naisbitt
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
3
|
Ben-Fredj N, Chahed F, Ben-Fadhel N, Mansour K, Ben-Romdhane H, Mabrouk RSE, Chadli Z, Ghedira D, Belhadjali H, Chaabane A, Aouam K. Case series of chronic spontaneous urticaria following COVID-19 vaccines: an unusual skin manifestation. Eur J Clin Pharmacol 2022; 78:1959-1964. [PMID: 36255482 PMCID: PMC9579615 DOI: 10.1007/s00228-022-03399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urticaria following the COVID-19 vaccine was rarely reported and had a short self-limited resolution. However, there has been relatively little literature published on CSU induced by COVID-19 vaccines. PURPOSE We describe a case series of patients who experienced CSU after SARS-CoV-2 vaccination. METHODS A retrospective case series of 10 patients referred to the Department of Clinical Pharmacology of the University of Monastir (January 2021-January 2022) and included for evaluation of urticaria after COVID-19 vaccination. RESULTS The median age was 31 years and patients were mostly female. Atopy was presented in 3 patients and urticaria was accompanied by angioedema in 6 patients. The median time interval between vaccination and the onset of urticaria was 28.5 h. The offended dose was the first one in 8 patients. The resolution of the eruption was observed at least 2 months later, despite the regular use of a full dose of antihistamine in nine patients. Polynuclear leucocytosis was identified in 5 patients. Anti-TPOAb was positive in one patient after receiving the BNT162b2 vaccine. Total serum IgE was elevated in 4 patients. Skin tests for the suspected vaccine as well as the vaccine excipient were negative. CONCLUSION We add to the medical literature ten new cases of chronic spontaneous urticarial reactions following COVID-19 vaccines uncontrolled with high-dose first-generation H1 antihistamines.
Collapse
Affiliation(s)
- Nadia Ben-Fredj
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Ferdaous Chahed
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia.
| | - Najah Ben-Fadhel
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Khadija Mansour
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Haifa Ben-Romdhane
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Randa Said El Mabrouk
- Department of Dermatology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Zohra Chadli
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Donia Ghedira
- Department of Chemistry, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Hichem Belhadjali
- Department of Dermatology, University Hospital of Monastir, The University of Monastir, Monastir, Tunisia
| | - Amel Chaabane
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| | - Karim Aouam
- Department of Clinical Pharmacology, Faculty of Medicine of Monastir, University Hospital, The University of Monastir, Monastir, Tunisia
| |
Collapse
|
4
|
Abstract
Cutaneous adverse drug reactions are undesirable cutaneous changes caused by medications. Drug eruptions can mimic a wide range of dermatoses that include exanthematous (morbilliform), urticarial, pustular, bullous, papulosquamous, or granulomatous lesions, and sometimes these eruptions may present with annular, polycyclic, or polymorphous configurations. The correct identification of a cutaneous drug eruption depends on a high index of suspicion, detailed medication exposure history, chronologic evaluation of the causal relationships between drug exposures and eruptions, and the exclusion of other infectious or idiopathic diseases. Most drug eruptions are annoying but self-limited, usually resolving after the withdrawal of the causative agents. Rarely, patients have severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS), which are potentially lethal adverse drug reactions that involve the skin and mucous membranes and may also damage internal organs. Prompt recognition of the alarming signs of severe cutaneous adverse reactions and providing adequate treatment may thus be life-saving. We present the main clinical presentations, histopathology, possible implicated medications, and treatment of cutaneous adverse drug reactions that can present in annular configurations.
Collapse
Affiliation(s)
- Wei-Hsin Wu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
5
|
Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma. Dermatopathology (Basel) 2022; 9:164-171. [PMID: 35645232 PMCID: PMC9149972 DOI: 10.3390/dermatopathology9020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
Maculopapular exanthem is a commonly encountered presentation in routine clinical practice, and differentiation between its two most common etiologies, i.e., viral- and drug-induced, often poses a diagnostic dilemma. Clinical, hematological and biochemical investigations are seldom reliable in distinguishing between a drug reaction and a viral exanthem. Certain key histopathological features such as the presence of a moderate degree of spongiosis, extensive basal cell damage with multiple necrotic keratinocytes and dermal infiltrate rich in eosinophils or lymphocytes and histiocytes may favor a drug exanthem, while distinctive epidermal cytopathic changes and lymphocytic vasculitis point towards a viral etiology. Similarly, notable immunohistochemical markers such as IL-5, eotaxin and FAS ligand may support a diagnosis of a drug-induced maculopapular eruption. Histopathological and immunohistochemical evaluations may help in distinguishing between the two etiologies when faced with a clinical overlap, especially in patients on multiple essential drugs when drug withdrawal and rechallenge is not feasible.
Collapse
|
6
|
Adimora-Onwuka D, Hall MAK. Beware the Unexpected Infection: Disseminated Varicella Zoster Virus Mimicking A Drug Eruption. J Investig Med High Impact Case Rep 2022; 10:23247096221117785. [PMID: 35968563 PMCID: PMC9379951 DOI: 10.1177/23247096221117785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Adverse cutaneous reactions to medications are not uncommon and may
resemble viral infection and vice versa, complicating diagnosis. We
describe the case of a 79-year-old male with cholangiocarcinoma with
liver and presumed lung metastasis who presented with abdominal pain
and was admitted with ileitis with partial small bowel obstruction. He
had a widespread papulovesicular rash with hemorrhagic center, mostly
on his face, chest, and back. The rash was initially thought to be a
drug eruption, but was eventually diagnosed via dermatopathological
examination as disseminated varicella zoster virus (VZV) infection.
Steroid treatment was discontinued, and airborne precautions were
initiated. Polymerase chain reaction for VZV was obtained and
intravenous acyclovir treatment was begun. This case of VZV, initially
suspected to be an adverse drug reaction, highlights the importance of
early identification of a highly infectious lesion and the importance
of early infection control measures, given the implications of
exposure to VZV for health care personnel.
Collapse
Affiliation(s)
- Dina Adimora-Onwuka
- Emory Saint Joseph’s Hospital, Atlanta, GA, USA
- Emory University School of Medicine, Division of Hospital Medicine, Atlanta, GA, USA
| | | |
Collapse
|
7
|
Kaplan Y, Goldberg I, Sprecher E, Slodownik D. Patch testing versus interferon-gamma release assay in evaluation of drug eruptions. Fundam Clin Pharmacol 2021; 36:414-420. [PMID: 34668222 DOI: 10.1111/fcp.12733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/06/2021] [Accepted: 10/17/2021] [Indexed: 12/27/2022]
Abstract
Delayed-onset T-cell-mediated cutaneous adverse drug reactions are an uncommon but potentially serious result of medication exposures. Identification of culprit medications is crucial, but clinical diagnosis is often difficult. Patch tests and interferon-gamma release assays (IFNγ-RA) were previously reported as potentially useful ancillary tests, while rechallenges remain the reference standard test. We compared the number of positive test results with patch testing and IFNγ-RA for drugs implicated as possible causes of cutaneous reactions. Fifty-one patients with a suspected cutaneous drug eruption underwent patch testing and IFNγ-RA for suspected drugs. Participants were followed up at least 9 months after the onset of the rash with results compared with the clinical diagnosis. Forty-two patients presented with morbilliform/eczematous eruptions; five were diagnosed with fixed drug eruption (FDE) and four with erythema multiforme. None had positive patch testing to the drugs tested. A total of 8/51 (15.6%) patients had positive reaction by the IFNγ-RA, and an additional 11 (21.6%) patients had borderline results. Positive or borderline results were more likely in patients with FDE (80%) than morbilliform/eczematous eruptions (30.9%) or erythema multiforme (25%). Our study emphasizes the necessity of additional effective ancillary tests in the evaluation of drug eruptions and supports the use of IFNγ-RA for drug testing as a tool for identifying medications associated with cutaneous drug eruptions.
Collapse
Affiliation(s)
- Yehonatan Kaplan
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Goldberg
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Tel Aviv University, Tel Aviv, Israel
| | - Dan Slodownik
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Torres MJ, Trautmann A, Böhm I, Scherer K, Barbaud A, Bavbek S, Bonadonna P, Cernadas JR, Chiriac AM, Gaeta F, Gimenez‐Arnau AM, Kang H, Moreno E, Brockow K. Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity. Allergy 2021; 76:1325-1339. [PMID: 33170954 DOI: 10.1111/all.14656] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022]
Abstract
Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%-3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re-exposition or drug provocation test should only be done with skin test-negative ICMs. The decision for performing either re-exposition or drug provocation test needs to be taken based on a risk-benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial.
Collapse
Affiliation(s)
- María José Torres
- Allergy Unit Regional University Hospital of Malaga‐IBIMA‐UMA‐ARADyAL Malaga Spain
| | - Axel Trautmann
- Department of Dermatology and Allergy University Hospital Würzburg Würzburg Germany
| | - Ingrid Böhm
- Department of Diagnostic, Interventional, and Pediatric Radiology Inselspital University of Bern Bern Switzerland
| | | | - Annick Barbaud
- Service de Dermatologie et Allergologie Sorbonne Université INSERM Institut Pierre Louis d’Epidemiologie et de Sante Publique AP‐HP Sorbonne Universite, Hopital Tenon Paris France
| | - Sevim Bavbek
- Department of Chest Disease Division of Immunology and Allergy School of Medicine Ankara University Ankara Turkey
| | | | | | - Anca Mirela Chiriac
- Department of Pulmonology Division of Allergy Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
| | - Francesco Gaeta
- Allergy Unit Columbus Hospital Agostino Gemelli IRCCS University Hospital Rome Italy
| | - Ana M. Gimenez‐Arnau
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma Barcelona Barcelona Spain
| | - Hye‐Ryun Kang
- Department of Internal Medicine Division of Allergy and Clinical Immunology Seoul National University College of Medicine Seoul Korea
| | - Esther Moreno
- Allergy Unit University Hospital of Salamanca‐IBSAL‐UMA‐ARADyAL Salamanca Spain
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein School of Medicine Technical University of Munich Munich Germany
| |
Collapse
|
9
|
Tong H, Phan NVT, Nguyen TT, Nguyen DV, Vo NS, Le L. Review on Databases and Bioinformatic Approaches on Pharmacogenomics of Adverse Drug Reactions. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:61-75. [PMID: 33469342 PMCID: PMC7812041 DOI: 10.2147/pgpm.s290781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/26/2020] [Indexed: 12/27/2022]
Abstract
Pharmacogenomics has been used effectively in studying adverse drug reactions by determining the person-specific genetic factors associated with individual response to a drug. Current approaches have revealed the significant importance of sequencing technologies and sequence analysis strategies for interpreting the contribution of genetic variation in developing adverse reactions. Advance in next generation sequencing and platform brings new opportunities in validating the genetic candidates in certain reactions, and could be used to develop the preemptive tests to predict the outcome of the variation in a personal response to a drug. With the highly accumulated available data recently, the in silico approach with data analysis and modeling plays as other important alternatives which significantly support the final decisions in the transformation from research to clinical applications such as diagnosis and treatments for various types of adverse responses.
Collapse
Affiliation(s)
- Hang Tong
- School of Biotechnology, International University, Ho Chi Minh City, Vietnam.,Vietnam National University, Ho Chi Minh City, Vietnam
| | - Nga V T Phan
- School of Biotechnology, International University, Ho Chi Minh City, Vietnam.,Vietnam National University, Ho Chi Minh City, Vietnam
| | - Thanh T Nguyen
- Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi, Vietnam
| | - Dinh V Nguyen
- Department of Respiratory, Allergy and Clinical Immunology, Vinmec International Hospital, Hanoi, Vietnam.,College of Health Sciences, VinUniversity, Hanoi, Vietnam
| | - Nam S Vo
- Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi, Vietnam
| | - Ly Le
- School of Biotechnology, International University, Ho Chi Minh City, Vietnam.,Vietnam National University, Ho Chi Minh City, Vietnam.,Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi, Vietnam
| |
Collapse
|
10
|
Gomes ESR, Marques ML, Regateiro FS. Epidemiology and Risk Factors for Severe Delayed Drug Hypersensitivity Reactions. Curr Pharm Des 2020; 25:3799-3812. [PMID: 31694518 DOI: 10.2174/1381612825666191105115346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
Severe delayed drug hypersensitivity reactions comprise different clinical entities and can involve different immune-mediated mechanisms. Common examples are severe cutaneous adverse reactions and druginduced internal organ injuries. The incidence of such reactions is overall low but seems to be on the rise reaching numbers as high as 9 per million individuals-years in the case of SJS/TEN and DRESS. Such conditions carry an important associated morbidity, and mortality can attain 40% in SJS/TEN patients, making these hypersensitivity reactions important targets when implementing preventive measures. Several risk factors have been identified for reaction severity; some are transverse, such as older age and underlying chronic diseases. The recent advances in pharmacogenetics allowed the identification of specific populations with higher risk and permitted strategic avoidance of certain drugs being HLA-B*57:01 screening in patients initiating abacavir the best successful example. In this work, we reviewed the epidemiology of SCARs and liver/kidney/lung drug-induced immune-mediated reactions. We focus on particular aspects such as prevalence and incidence, drugs involved, mortality and risk factors.
Collapse
Affiliation(s)
- Eva S R Gomes
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal
| | - Maria L Marques
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Reseach (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
11
|
Naisbitt DJ, Olsson‐Brown A, Gibson A, Meng X, Ogese MO, Tailor A, Thomson P. Immune dysregulation increases the incidence of delayed-type drug hypersensitivity reactions. Allergy 2020; 75:781-797. [PMID: 31758810 DOI: 10.1111/all.14127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/05/2019] [Accepted: 11/18/2019] [Indexed: 12/14/2022]
Abstract
Delayed-type, T cell-mediated, drug hypersensitivity reactions are a serious unwanted manifestation of drug exposure that develops in a small percentage of the human population. Drugs and drug metabolites are known to interact directly and indirectly (through irreversible protein binding and processing to the derived adducts) with HLA proteins that present the drug-peptide complex to T cells. Multiple forms of drug hypersensitivity are strongly linked to expression of a single HLA allele, and there is increasing evidence that drugs and peptides interact selectively with the protein encoded by the HLA allele. Despite this, many individuals expressing HLA risk alleles do not develop hypersensitivity when exposed to culprit drugs suggesting a nonlinear, multifactorial relationship in which HLA risk alleles are one factor. This has prompted a search for additional susceptibility factors. Herein, we argue that immune regulatory pathways are one key determinant of susceptibility. As expression and activity of these pathways are influenced by disease, environmental and patient factors, it is currently impossible to predict whether drug exposure will result in a health benefit, hypersensitivity or both. Thus, a concerted effort is required to investigate how immune dysregulation influences susceptibility towards drug hypersensitivity.
Collapse
Affiliation(s)
- Dean J. Naisbitt
- MRC Centre for Drug Safety Science Department of Clinical and Molecular Pharmacology The University of Liverpool Liverpool UK
| | - Anna Olsson‐Brown
- MRC Centre for Drug Safety Science Department of Clinical and Molecular Pharmacology The University of Liverpool Liverpool UK
| | - Andrew Gibson
- MRC Centre for Drug Safety Science Department of Clinical and Molecular Pharmacology The University of Liverpool Liverpool UK
| | - Xiaoli Meng
- MRC Centre for Drug Safety Science Department of Clinical and Molecular Pharmacology The University of Liverpool Liverpool UK
| | - Monday O. Ogese
- MRC Centre for Drug Safety Science Department of Clinical and Molecular Pharmacology The University of Liverpool Liverpool UK
| | - Arun Tailor
- MRC Centre for Drug Safety Science Department of Clinical and Molecular Pharmacology The University of Liverpool Liverpool UK
| | - Paul Thomson
- MRC Centre for Drug Safety Science Department of Clinical and Molecular Pharmacology The University of Liverpool Liverpool UK
| |
Collapse
|
12
|
Hammond S, Thomson PJ, Ogese MO, Naisbitt DJ. T-Cell Activation by Low Molecular Weight Drugs and Factors That Influence Susceptibility to Drug Hypersensitivity. Chem Res Toxicol 2019; 33:77-94. [PMID: 31687800 DOI: 10.1021/acs.chemrestox.9b00327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Drug hypersensitivity reactions adversely affect treatment outcome, increase the length of patients' hospitalization, and limit the prescription options available to physicians. In addition, late stage drug attrition and the withdrawal of licensed drugs cost the pharmaceutical industry billions of dollars. This significantly increases the overall cost of drug development and by extension the price of licensed drugs. Drug hypersensitivity reactions are characterized by a delayed onset, and reactions tend to be more serious upon re-exposure. The role of drug-specific T-cells in the pathogenesis of drug hypersensitivity reactions and definition of the nature of the binding interaction of drugs with HLA and T-cell receptors continues to be the focus of intensive research, primarily because susceptibility is associated with expression of one or a small number of HLA alleles. This review critically examines the mechanisms of T-cell activation by drugs. Specific examples of drugs that activate T-cells via the hapten, the pharmacological interaction with immune receptors and the altered self-peptide repertoire pathways, are discussed. Furthermore, the impacts of drug metabolism, drug-protein adduct formation, and immune regulation on the development of drug antigen-responsive T-cells are highlighted. The knowledge gained from understanding the pathways of T-cell activation and susceptibility factors for drug hypersensitivity will provide the building blocks for the development of predictive in vitro assays that will prevent or help to minimize the incidence of these reactions in clinic.
Collapse
Affiliation(s)
- Sean Hammond
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
| | - Paul J Thomson
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
| | - Monday O Ogese
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
| | - Dean J Naisbitt
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool L69 3GE , U.K
| |
Collapse
|
13
|
Krispinsky AJ, Shedlofsky LB, Kaffenberger BH. The frequency of low‐risk morbilliform drug eruptions observed in patients treated with different classes of antibiotics. Int J Dermatol 2019; 59:647-655. [DOI: 10.1111/ijd.14703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Andrew J. Krispinsky
- Division of Dermatology Department of Internal Medicine The Ohio State University Columbus OH USA
| | | | - Benjamin H. Kaffenberger
- Division of Dermatology Department of Internal Medicine The Ohio State University Columbus OH USA
| |
Collapse
|
14
|
Balato A, Raimondo A, Arenberger P, Bruze M, Czarnecka-Operacz M, Johanssen JD, Gonçalo M, Ranki A, Uter W, Wilkinson M, Ayala F, John SM, Giménez-Arnau A, Gollnick H. The role of the dermatologist in the immune-mediated/allergic diseases - position statement of the EADV task force on contact dermatitis, EADV task force on occupational skin diseases, UEMS-EBDV subcommission allergology and European Dermatology Forum. J Eur Acad Dermatol Venereol 2019; 33:1459-1464. [PMID: 31062452 DOI: 10.1111/jdv.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The members of the Task Force on Contact Dermatitis and the Task Force on Occupational Dermatoses of the European Academy of Dermatology and Venereology (EADV), of the European Dermatology Forum (EDF), and the members of the UEMS Section of Dermatology-Venereology (UEMS-EBDV) we want to vindicate the fundamental role that the specialist in Dermatology has in the diagnosis and management of Immuno-mediated /allergic Diseases. OBJECTIVE In disagreement with the blueprint paper of the UEMS section of Allergology (2013), in which dermatologists are excluded from one of their core activities it was decided to write this consensus paper. DISCUSSION The skin occupies a crucial place in the broad spectrum of allergic diseases; there is no other organ with such a multitude of different clinical conditions mediated by so many pathogenetic immune mechanisms. Subsequently, dermatologists play a fundamental role in the management of immune-mediated diseases including among others contact dermatitis, atopic dermatitis, urticaria and angioedema or cutaneous adverse drug, food and arthropod reactions. The essential role of dermatology in the diagnostic, therapeutic and preventive management of immune mediated /allergic diseases which is crucial for patient management is justified from both the academic and professional point of view. CONCLUSION Based on the best care of the patient with cutaneous immune allergic disease a multidisciplinary approach is desirable and the dermatologist has a pivotal role in patient management. Be so good and no one will not ignore you, dermatologist. Ideally Dermatology should be governed according the following Henry Ford statement: "Arriving together is the beginning; keeping together is progress; working together is success."
Collapse
Affiliation(s)
- A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - A Raimondo
- Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - P Arenberger
- Department of Dermatology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - M Czarnecka-Operacz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - J D Johanssen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Ranki
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - W Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Wilkinson
- Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Ayala
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - S M John
- Department of Dermatology, Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany
| | - A Giménez-Arnau
- Department of Dermatology, Hospital del Mar. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - H Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke Universität, Magdeburg, Germany
| |
Collapse
|
15
|
Samuelov L, Nathan A, Slutsky E, Fruchter D, Gat A, Sprecher E, Goldberg I. Nested case–control study investigating the diagnostic role of tissue eosinophilia in adverse cutaneous drug reactions. J Eur Acad Dermatol Venereol 2019; 33:1152-1157. [DOI: 10.1111/jdv.15509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/18/2019] [Indexed: 12/21/2022]
Affiliation(s)
- L. Samuelov
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - A. Nathan
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - E. Slutsky
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - D. Fruchter
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - A. Gat
- Institute of Pathology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - E. Sprecher
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - I. Goldberg
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| |
Collapse
|
16
|
Ben Ami T, Sarig O, Sprecher E, Goldberg I. Glutathione S-transferase polymorphisms in patients with photosensitive and non-photosensitive drug eruptions. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:214-220. [PMID: 30737837 DOI: 10.1111/phpp.12454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/03/2018] [Accepted: 02/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Glutathione S-transferases (GSTs) play a critical role in cellular protection against oxidative damage. Polymorphisms in three major GST loci have been described. A number of studies have looked for an association between GSTs and skin diseases. PURPOSE To ascertain the possibility that polymorphisms in the GSTM1, GSTT1, and GSTP1 genes may predict the development of photo-induced and non-photo-induced drug eruptions. METHODS A cohort of 40 patients with drug eruptions, 10 of whom had developed a photo-induced drug reaction, and matched controls (116 for GSTM1 and GSTT1, 120 for GSTP1) were studied. Genotyping was conducted using direct sequencing and polymerase chain reaction. RESULTS The GSTP1 Val/Val genotype was significantly associated with non-photosensitive drug eruptions (OR = 3.64, P value = 0.038), whereas associations observed between GSTP1, GSTM1, GSTT1 polymorphisms and photosensitive drug eruptions did not reach statistical significance. CONCLUSIONS Variations in GSTP1 may affect the risk to develop non-photo-induced drug eruptions. These results warrant confirmatory studies in a larger patient sample.
Collapse
Affiliation(s)
- Tal Ben Ami
- Department of Dermatology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Sarig
- Department of Dermatology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldberg
- Department of Dermatology, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Drug-Induced Skin Adverse Reactions: The Role of Pharmacogenomics in Their Prevention. Mol Diagn Ther 2018; 22:297-314. [PMID: 29564734 DOI: 10.1007/s40291-018-0330-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adverse drug reactions (ADRs) affect many patients and remain a major public health problem, as they are a common cause of morbidity and mortality. It is estimated that ADRs are responsible for about 6% of hospital admissions and about 9% of hospitalization costs. Skin is the organ that is most frequently involved in ADRs. Drug-induced skin injuries vary from mild maculopapular eruptions (MPE) to severe cutaneous adverse reactions (SCARs) that are potentially life threatening. Genetic factors have been suggested to contribute to these SCARs, and most significant genetic associations have been identified in the major histocompatibility complex (MHC) genes. Common drugs associated with SCARs connected with strong genetic risk factors include antiepileptic drugs (AEDs), allopurinol, abacavir, nevirapine, sulfonamides, dapsone, non-steroidal anti-inflammatory drugs (NSAIDs), and analgesic drugs. However, genetic associations vary between different ethnic populations. Differences may in part be explained by the different prevalence of HLA (human leukocyte antigen) alleles among ethnic groups. In this review, we present and discuss the recent advances in genetic associations with ADRs in the skin. Many of these ADRs are now preventable with pharmacogenetic screening.
Collapse
|
18
|
Syu FK, Pan HY, Chuang PC, Huang YS, Cheng CY, Cheng FJ. Incidence of Stevens-Johnson syndrome following combination drug use of allopurinol, carbamazepine and phenytoin in Taiwan: A case-control study. J Dermatol 2018; 45:1080-1087. [DOI: 10.1111/1346-8138.14528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Fei-Kai Syu
- Department of Pharmacy; College of Pharmacy; China Medical School; Taichung Taiwan
| | - Hsiu-Yung Pan
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Po-Chun Chuang
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Yi-Syun Huang
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chi-Yung Cheng
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| |
Collapse
|
19
|
Brandt O, Bircher AJ. Spättypreaktionen auf oral und parenteral verabreichte Arzneimittel. J Dtsch Dermatol Ges 2017. [DOI: 10.1111/ddg.13362_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Oliver Brandt
- Allergologische Poliklinik; Dermatologische Klinik; Universitätsspital Basel; Schweiz
| | - Andreas J. Bircher
- Allergologische Poliklinik; Dermatologische Klinik; Universitätsspital Basel; Schweiz
| |
Collapse
|
20
|
Brandt O, Bircher AJ. Delayed-type hypersensitivity to oral and parenteral drugs. J Dtsch Dermatol Ges 2017; 15:1111-1132. [PMID: 29106000 DOI: 10.1111/ddg.13362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/07/2017] [Indexed: 01/22/2023]
Abstract
Adverse drug reactions of the delayed type rank among the most common dermatoses and are predominantly characterized by exanthematous macular or maculopapular eruptions. However, approximately 2 % of affected individuals develop severe or even life-threatening systemic immune reactions associated with organ involvement, requiring immediate diagnosis and treatment. Numerous drugs are capable of eliciting delayed-type hypersensitivity reactions, with antibiotics, anticonvulsant drugs, and the xanthine oxidase inhibitor allopurinol being the most common. Apart from genetic susceptibility, predisposing factors for the development of drug hypersensitivity reactions include high drug doses, polypharmacy, long treatment duration, female gender, as well as acute or chronic infections.
Collapse
Affiliation(s)
- Oliver Brandt
- Allergy Unit, Department of Dermatology, Basel University Hospital, Basel, Switzerland
| | - Andreas J Bircher
- Allergy Unit, Department of Dermatology, Basel University Hospital, Basel, Switzerland
| |
Collapse
|
21
|
Singh S, Khandpur S, Arava S, Rath R, Ramam M, Singh M, Sharma VK, Kabra SK. Assessment of histopathological features of maculopapular viral exanthem and drug-induced exanthem. J Cutan Pathol 2017; 44:1038-1048. [DOI: 10.1111/cup.13047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Sanjay Singh
- Department of Dermatology and Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Sujay Khandpur
- Department of Dermatology and Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Sudheer Arava
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - Ramashankar Rath
- Department of Centre for Community Medicine; All India Institute of Medical Sciences; New Delhi India
| | - M. Ramam
- Department of Dermatology and Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Manoj Singh
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - Vinod K. Sharma
- Department of Dermatology and Venereology; All India Institute of Medical Sciences; New Delhi India
| | - Sushil Kumar Kabra
- Department of Paediatrics; All India Institute of Medical Sciences; New Delhi India
| |
Collapse
|
22
|
Mockenhaupt M. Epidemiology of cutaneous adverse drug reactions. Allergol Select 2017; 1:96-108. [PMID: 30402608 PMCID: PMC6039997 DOI: 10.5414/alx01508e] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/02/2012] [Indexed: 12/14/2022] Open
Abstract
Epidemiologic investigation of cutaneous adverse drug reactions (cADRs) is important in order to evaluate their impact on dermatology and health care in general as well as their burden on affected patients. Few epidemiologic studies have been performed on frequent non-life-threatening cADR, including reactions of both delayed and immediate hypersensitivity, such as maculopapular exanthema (MPE), fixed drug eruption, and urticaria. Concerning rare but life-threatening severe cutaneous adverse reactions, e.g., toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS), several epidemiologic studies have been performed to date, some of which are still ongoing. Such studies enable the calculation of reliable incidence rates and demographic data, and also allow researchers to perform risk estimation for drugs. The spectrum of drugs causing cADR differs substantially when separating the various clinical conditions. Whereas antibiotics are by far the most frequent inducers of milder cADRs, like MPE, they have a much lower risk of inducing SJS/TEN, for which "high-risk" drugs are anti-infective sulfonamides, allopurinol, certain anti-epileptic drugs, nevirapine, and non-steroidal anti-inflammatory drugs (NSAIDs) of the oxicam-type. In contrast, AGEP is predominantly caused by the antibiotics pristinamycin and aminopenicillins, followed by quinolones, (hydroxy-)chloroquine, and sulfonamides. DRESS can be induced by a number of drugs known to cause SJS/TEN, such as certain antiepileptics and allopurinol, but also other medications (e.g., minocyclin).
Collapse
Affiliation(s)
- M Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Universitäts-Hautklinik Freiburg, Germany
| |
Collapse
|
23
|
Romano A, Valluzzi RL, Caruso C, Maggioletti M, Gaeta F. Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis. Curr Allergy Asthma Rep 2017; 17:23. [PMID: 28382604 DOI: 10.1007/s11882-017-0691-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-immediate cutaneous reactions (i.e., occurring at least 1 h after the initial drug administration), particularly maculopapular exanthemas and urticarial eruptions, are common during beta-lactam treatments. A T cell-mediated pathogenic mechanism has been demonstrated in some cutaneous reactions, such as maculopapular exanthema, fixed drug eruption, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome. In the diagnostic work-up, patch testing is useful, together with delayed-reading intradermal testing. Patch tests are a simple and safe diagnostic tool, which in the case of severe reactions should be used as the first line of investigation. However, patch tests are less sensitive than intradermal tests, which are preferable in subjects with mild reactions. Lymphocyte transformation or activation tests and enzyme-linked immunosorbent spot assays can be used as complementary tests. In selected cases of mild or moderate reactions, displaying negative results in the aforesaid allergy tests, a graded challenge with the implicated beta-lactam can be performed.
Collapse
Affiliation(s)
- Antonino Romano
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy. .,IRCCS Oasi Maria S.S, Troina, Italy.
| | - Rocco Luigi Valluzzi
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy.,Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Cristiano Caruso
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy
| | | | - Francesco Gaeta
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy
| |
Collapse
|
24
|
Fang H, Lin X, Zhang J, Hong Z, Sugiyama K, Nozaki T, Sameshima T, Kobayashi S, Namba H, Asakawa T. Multifaceted interventions for improving spontaneous reporting of adverse drug reactions in a general hospital in China. BMC Pharmacol Toxicol 2017; 18:49. [PMID: 28651624 PMCID: PMC5485713 DOI: 10.1186/s40360-017-0159-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study investigates changes in spontaneous reporting (SR) compliance and ADR patterns following adoption of a new hospital SR system, and multiple interventions designed for its improvement use under modified drug administration guidelines. METHODS In total, 1389 ADR cases were reviewed. Cases were divided into two groups, cases from period 1 (n = 557, from January 2006 to June 2011) under the old SR system and cases in period 2 (n = 832, from July 2011 to December 2016) under the new SR system with multiple interventions to improve physician SR compliance. General information, drug information, and clinical manifestations were investigated and compared between periods. RESULTS Interventions for improved clinician training, education on knowledge, attitudes, and practices (KAP), and economic incentives substantially improved SR adherence. We also found that changing drug usage patterns (based on the new drug administration guidelines) greatly influenced ADR occurrence and type. CONCLUSIONS We found the SR compliance can be improved by multifaceted interventions. Drug usage patterns also influence ADR occurrence, so programs tailored for rational use are essential. These results could lead to further improvements in the SR system for ADRs in China, and provide guidance for establishing better methods of pharmacovigilance.
Collapse
Affiliation(s)
- Huan Fang
- Department of Pharmacy, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Xiaowen Lin
- Department of Pharmacy, Jinshan Central Hospital, No 147 Jiankang Road, Shanghai, 201500, People's Republic of China
| | - Jun Zhang
- Department of Pharmacy, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, No. 12 Urumchizhong Road, Shanghai, 200040, People's Republic of China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan
| | - Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan.
| |
Collapse
|
25
|
Wang F, Zhao YK, Li M, Zhu Z, Zhang X. Trends in culprit drugs and clinical entities in cutaneous adverse drug reactions: a retrospective study. Cutan Ocul Toxicol 2017; 36:370-376. [PMID: 28423957 DOI: 10.1080/15569527.2017.1301947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fang Wang
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,
| | - Yu-Kun Zhao
- Department of Dermatology, Eastern Hospital of First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and
| | - Minyi Li
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,
| | - Zhe Zhu
- Department of Stem Cell Biology and Regenerative Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Xingqi Zhang
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,
| |
Collapse
|
26
|
Ramírez E, Bellón T, Tong HY, Borobia AM, de Abajo FJ, Lerma V, Moreno Hidalgo MA, Castañer JL, Cabañas R, Fiandor A, González-Ramos J, Herranz P, Cachafeiro L, González-Herrada C, González O, Aramburu JA, Laosa O, Hernández R, Carcas AJ, Frías J. Significant HLA class I type associations with aromatic antiepileptic drug (AED)-induced SJS/TEN are different from those found for the same AED-induced DRESS in the Spanish population. Pharmacol Res 2016; 115:168-178. [PMID: 27888155 DOI: 10.1016/j.phrs.2016.11.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Abstract
Aromatic antiepileptic drugs (AEDs) are among the drugs most frequently involved in severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reactions with eosinophilia and systemic symptoms (DRESS). This study investigated the associations between the genetic polymorphisms of HLA class-I and AED-induced SCARs in the Spanish population. HLA class-I genotypes were determined in AED (phenytoin[PHT],lamotrigine[LTG],carbamazepine[CBZ],phenobarbital[PB])-induced SJS/TEN (n=15) or DRESS (n=12) cases included in the Spanish SCAR registry, PIELenRed. There were 3 control groups: (A)tolerant to a single AED, (B)tolerant to any AED, and (C)Spanish population controls. For SJS/TEN, concomitant HLA-A*02:01/Cw15:02 alleles were significantly associated with PHT-cases compared to control groups B and C [(B)odds ratio(OR):14.75, p=0.009;(C)OR:27.50, p<0.001], and were close to significance with respect to control group A (p=0.060). The genotype frequency of the HLA-B*38:01 was significantly associated with PHT-LTG-cases compared with the 3 groups of controls [(A)OR:12.86, p=0.012;(B)OR:13.81; p=0.002;(C)OR:14.35, p<0.001], and with LTG-cases [(A)OR:147.00, p=0.001;(B)OR:115.00, p<0.001;(C)OR:124.70, p<0.001]. We found the HLA-B*15:02 allele in a Spanish Romani patient with a CBZ-case. The HLA-A*11:01 was significantly associated with CBZ-cases [(A)OR:63.89, p=0.002;(B)OR:36.33, p=0.005;(C)OR:28.29, p=0.007]. For DRESS, the HLA-A*24:02 genotype frequency was statistically significant in the PHT-LTG-cases [(A)OR:22.56, p=0.003;(B)OR:23.50. p=0.001; (C)OR:33.25, p<0.001], and in the LTG-cases [(A),OR:49.00, p=0.015;(B)OR:27.77, p=0.005; (C)OR:34.53, p=0.002]. HLA-A*31:01 was significantly associated with the CBZ-cases [(A)OR:22.00, p=0.047;(B)OR:29.50, p=0.033;(C)OR:35.14, p=0.006]. In conclusion, we identified several significant genetic risk factors for the first time in the Spanish Caucasian population: HLA-A*02:01/Cw*15:02 combination as a risk factor for PHT-induced SJS/TEN, HLA-B*38:01 for LTG- and PHT- induced SJS/TEN, HLA-A*11:01 for CBZ-induced SJS/TEN, and HLA-A*24:02 for LTG- and PHT- induced DRESS. The strong association between HLA*31:01 and CBZ-DRESS in Europeans was confirmed in this study.
Collapse
Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain.
| | - Teresa Bellón
- Institute for Health Research, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Hoi Y Tong
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Alberto M Borobia
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences (Pharmacology), University of Alcalá, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences (Pharmacology), University of Alcalá, Madrid, Spain
| | | | - José L Castañer
- Immunology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Rosario Cabañas
- Allergy Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Ana Fiandor
- Allergy Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | | | - Pedro Herranz
- Dermatology Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Lucía Cachafeiro
- Intensive Care Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | | | - Olga González
- Dermatology Department, Getafe University Hospital, Madrid, Spain
| | - José A Aramburu
- Pathological Anatomy Department, Getafe University Hospital, Madrid, Spain
| | - Olga Laosa
- Clinical Pharmacology Unit, Geriatric Department, Getafe University Hospital, Madrid, Spain
| | - Rafael Hernández
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Antonio J Carcas
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Jesús Frías
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain.
| |
Collapse
|
27
|
Mehta N, Chen KK, Kroumpouzos G. Skin disease in pregnancy: The approach of the obstetric medicine physician. Clin Dermatol 2016; 34:320-6. [DOI: 10.1016/j.clindermatol.2016.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
28
|
Marzano AV, Borghi A, Cugno M. Adverse drug reactions and organ damage: The skin. Eur J Intern Med 2016; 28:17-24. [PMID: 26674736 DOI: 10.1016/j.ejim.2015.11.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
Cutaneous adverse drug reactions are frequent, affecting 2-3% of hospitalized patients and in one twentieth of them are potentially life-threatening. Almost any pharmacologic agent can induce skin reactions, and certain drug classes, such as non-steroidal anti-inflammatory drugs, antibiotics and antiepileptics, have drug eruption rates ranging from 1% to 5%. Cutaneous drug reactions recognize several different pathomechanisms: some skin manifestations are immune-mediated like allergic reactions while others are the result of non immunological causes such as cumulative toxicity, photosensitivity, interaction with other drugs or different metabolic pathways. Cutaneous adverse drug reactions can be classified into two groups: common non-severe and rare life-threatening adverse drug reactions. Non-severe reactions are often exanthematous or urticarial whereas life-threatening reactions typically present with skin detachment or necrosis of large areas of the body and mucous membrane involvement, as in the Stevens-Johnson syndrome or toxic epidermal necrolysis. Clinicians should carefully evaluate the signs and symptoms of all cutaneous adverse drug reactions thought to be due to drugs and immediately discontinue drugs that are not essential. Short cycles of systemic corticosteroids in combination with antihistamines may be necessary for widespread exanthematous rashes, while more aggressive corticosteroid regimens or intravenous immunoglobulins associated with supportive treatment should be used for patients with Stevens-Johnson syndrome or toxic epidermal necrolysis.
Collapse
Affiliation(s)
- Angelo V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandro Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Massimo Cugno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
| |
Collapse
|
29
|
Thompson RA, Isin EM, Ogese MO, Mettetal JT, Williams DP. Reactive Metabolites: Current and Emerging Risk and Hazard Assessments. Chem Res Toxicol 2016; 29:505-33. [DOI: 10.1021/acs.chemrestox.5b00410] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Richard A. Thompson
- DMPK, Respiratory, Inflammation & Autoimmunity iMed, AstraZeneca R&D, 431 83 Mölndal, Sweden
| | - Emre M. Isin
- DMPK, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, 431 83 Mölndal, Sweden
| | - Monday O. Ogese
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Rd, Cambridge CB4 0FZ, United Kingdom
| | - Jerome T. Mettetal
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, 35 Gatehouse Dr, Waltham, Massachusetts 02451, United States
| | - Dominic P. Williams
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Rd, Cambridge CB4 0FZ, United Kingdom
| |
Collapse
|
30
|
Valeyrie-Allanore L, Lebrun-Vignes B, Bensaid B, Sassolas B, Barbaub A. Érythème pigmenté fixe : épidémiologie, physiopathologie, clinique, diagnostic différentiel et modalités de prise en charge. Ann Dermatol Venereol 2015; 142:701-6. [DOI: 10.1016/j.annder.2015.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/06/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
|
31
|
Utility of ICD-9-CM Codes for Identification of Allergic Drug Reactions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:114-9.e1. [PMID: 26372539 DOI: 10.1016/j.jaip.2015.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/03/2015] [Accepted: 07/21/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The epidemiology of allergic drug reactions is poorly understood due, in large part, to difficulty in identifying true cases in population data sets. Use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes is a potentially valuable approach that requires formal evaluation. OBJECTIVE To better understand the utility of ICD-9-CM codes for identification of allergic drug reactions, including the validation of specific codes by chart review. METHODS We reviewed randomly sampled medical records of patients treated in the emergency department (ED) between January 1, 2001, and December 31, 2006, with ICD-9-CM codes for drug allergy and E codes (E930-949) for adverse drug reactions. RESULTS During the 6-year period, 11,130 charts were identified by ICD-9-CM and E codes and 1,634 were reviewed. Allergic drug reactions were found in 444 (27%) of the reviewed ED visits. The codes that identified the highest percentage of true allergic drug reactions were dermatitis due to drug (693.0; 87%), adverse reaction to drug (995.2; 52%), and anaphylaxis (995.0; 38%). Patients with both an ICD-9-CM code and an E code had a high likelihood of having an allergic drug reaction (76%). Most allergic drug reactions were attributed to antibiotics (42%), intravenous contrast (7%), and nonsteroidal anti-inflammatory drugs (6%). The estimated frequency of allergic drug reactions increased from 0.49% of ED visits in 2001 to 0.94% in 2012. CONCLUSIONS Specific ICD-9-CM and E codes can be used in combination to identify allergic drug reactions. Further study of these codes in the inpatient and outpatient settings is necessary to better understand the utility of diagnosis codes for improving epidemiologic research on drug allergy.
Collapse
|
32
|
Association of CD8(+) T lymphocyte repertoire spreading with the severity of DRESS syndrome. Sci Rep 2015; 5:9913. [PMID: 25905582 PMCID: PMC4649994 DOI: 10.1038/srep09913] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/12/2015] [Indexed: 12/17/2022] Open
Abstract
T-cell receptor (TCR)-mediated cross-recognition is a major mechanism in the pathogenesis of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. However, the characteristics of the TCR repertoire and the clinical significance of repertoire reformation throughout the course of DRESS are unknown. Here, we isolated CD4(+) and CD8(+) T-cells from peripheral blood of 8 DRESS patients at 10-day intervals and, sequenced CDR3-regions of the TCRB chain by high-throughput sequencing to analyze the dynamic reformation in the T-cell repertoire hierarchy. Compared with healthy donors, T-cell expanded in peripheral repertoires from DRESS patient. The extent of fluctuation of dominant CD8(+) T-cell clones, but not of CD4(+) counterparts, correlated positively with the clinical severity and helped classify the enrolled subjects into "fluctuant" and "flat" repertoire groups. The anti-herpesvirus response, which was measured using anti-EBV/HHV antibodies, and the proportion of the homologous CD8(+) EBV-specific clonotypes, in the "fluctuant" group was substantial higher than that in the "flat" group. Furthermore, autoimmune sequelae were observed in a cured "fluctuant" patient. Collectively, the clinical relevance of the fluctuant CD8(+) T-cell repertoires supports the notion that herpes virus-mediated continuously de novo priming of newly pathogenic CD8(+) T-cell clones is an alternate mechanism responsible for the pathogenicity of DRESS.
Collapse
|
33
|
Lebrun-Vignes B, Valeyrie-Allanore L. Toxidermies. Rev Med Interne 2015; 36:256-70. [DOI: 10.1016/j.revmed.2014.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 07/15/2014] [Accepted: 10/08/2014] [Indexed: 12/17/2022]
|
34
|
Borroni RG. Role of dermatology in pharmacogenomics: drug-induced skin injury. Pharmacogenomics 2015; 16:401-12. [PMID: 25823788 DOI: 10.2217/pgs.15.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Different individuals may respond diversely to the same drug, in terms of efficacy and toxicity. Adverse drug reactions cause about 6% of all hospital admissions and account for up to 9% of hospitalization costs. Drug-induced skin injury (DISI) is the most common presentation of adverse drug reactions, ranging from maculopapular eruptions to severe adverse cutaneous drug reactions (SCARs) with mortality of up to 40%. Specific genetic polymorphisms confer susceptibility to different types of DISI. Identifying patients genetically at risk for SCARs is one of the goals of pharmacogenomics. In this article, the aspects of clinical dermatology relevant to the pharmacogenetics of DISI are reviewed. Many SCARs are now preventable, with consequent reduction of morbidity, mortality and healthcare costs.
Collapse
|
35
|
Farshchian M, Ansar A, Zamanian A, Rahmatpour-Rokni G, Kimyai-Asadi A, Farshchian M. Drug-induced skin reactions: a 2-year study. Clin Cosmet Investig Dermatol 2015; 8:53-6. [PMID: 25709487 PMCID: PMC4330003 DOI: 10.2147/ccid.s75849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The aim of this study was to analyze the clinical characteristics of patients with adverse cutaneous drug reactions, which occur when a medicinal product results in cutaneous morbidity. Methods The study included 308 patients who were diagnosed as having an adverse cutaneous drug reaction during the study period (2007–2009). In 84 cases, histopathologic examination of skin biopsies were also performed. Results Patients with drug reactions were found to be more commonly female (63%) than male (37%). Beta-lactam antibiotics were found to be the most frequent cause of adverse cutaneous drug reactions (42.7%), followed by non-steroidal anti-inflammatory drugs (16.5%). Acute urticaria was the most common clinical presentation (59.2%) followed by fixed drug eruptions (18.5%), and maculopapular eruptions (14.9%). Conclusion Adverse cutaneous drug reactions in our study population were mainly induced by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The most common forms of cutaneous adverse drug reactions were found to be acute urticaria, fixed drug eruptions, and maculopapular rashes.
Collapse
Affiliation(s)
- Mahmood Farshchian
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Akram Ansar
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Abbas Zamanian
- Department of Dermatology, Iran University of Medical Sciences, Tehran, Iran
| | - Ghasem Rahmatpour-Rokni
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | | | - Mehdi Farshchian
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran ; Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
36
|
Sullivan A, Gibson A, Park BK, Naisbitt DJ. Are drug metabolites able to cause T-cell-mediated hypersensitivity reactions? Expert Opin Drug Metab Toxicol 2014; 11:357-68. [DOI: 10.1517/17425255.2015.992780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
37
|
Çelik G, Karakaya G, Öztürk A, Gelincik A, Abadoğlu Ö, Sin A, Damadoğlu E, Yılmaz İ, Demirtürk M, Dursun B, Özdemir S, Çelikel S, Değirmenci P, Bozkurt B, Göksel Ö, Erkekol F, Aydın Ö, Kavut A, Kırmaz C, Kalpaklıoğlu F, Büyüköztürk S, Kalyoncu F. Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey. Allergol Immunopathol (Madr) 2014; 42:573-9. [PMID: 24269184 DOI: 10.1016/j.aller.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/01/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. METHODS This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. RESULTS Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. CONCLUSION Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.
Collapse
|
38
|
Perkins JR, Ariza A, Blanca M, Fernández TD. Tests for evaluating non-immediate allergic drug reactions. Expert Rev Clin Immunol 2014; 10:1475-86. [DOI: 10.1586/1744666x.2014.966691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
39
|
Macy E, Contreras R. Adverse reactions associated with oral and parenteral use of cephalosporins: A retrospective population-based analysis. J Allergy Clin Immunol 2014; 135:745-52.e5. [PMID: 25262461 DOI: 10.1016/j.jaci.2014.07.062] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/07/2014] [Accepted: 07/09/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Few studies have provided population-based, route-specific data on allergy to cephalosporin or incidence of serious adverse drug reactions (ADRs). OBJECTIVE We investigated the incidence of new reports of cephalosporin-associated "allergy" and serious ADRs. METHODS We identified all members of the Kaiser Permanente Southern California health plan given cephalosporins (from January 1, 2010, through December 31, 2012), all new reports of cephalosporin-associated allergy, and all serious ADRs. RESULTS There were 622,456 health plan members exposed to 901,908 courses of oral cephalosporins and 326,867 members exposed to 487,630 courses of parenteral cephalosporins over the 3-year study period. New reports of allergy to cephalosporin were more frequent among women (0.56%; 95% CI, 0.54% to 0.57%) than among men (0.43%; 95% CI, 0.41% to 0.44%) per course (P < .0001). The most frequent serious cephalosporin-associated ADRs were Clostridium difficile infection within 90 days (0.91%), nephropathy within 30 days (0.15%), and all-cause death within 1 day (0.10%). None correlated with history of drug allergy. Physician-documented cephalosporin-associated anaphylaxis occurred with 5 oral exposures (95% CI, 1/1,428,571-1/96,154) and 8 parenteral exposures (95% CI, 1/200,000-1/35,971) (P = .0761). There were 3 documented cephalosporin-associated serious cutaneous adverse reactions (95% CI, 0-1 in 217,291). All were associated with the use of another antibiotic at the same time as cephalosporin. CONCLUSIONS Cephalosporins are widely and safely used, even in individuals with a history of penicillin allergy. Physician-documented cephalosporin-associated anaphylaxis and serious cutaneous adverse reactions are rare compared with C difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day.
Collapse
Affiliation(s)
- Eric Macy
- Department of Allergy, Southern California Permanente Medical Group, San Diego Medical Center, San Diego, Calif.
| | - Richard Contreras
- Department of Research and Evaluation, Kaiser Permanente Health Care Program, Pasadena, Calif
| |
Collapse
|
40
|
Roujeau JC, Haddad C, Paulmann M, Mockenhaupt M. Management of Nonimmediate Hypersensitivity Reactions to Drugs. Immunol Allergy Clin North Am 2014; 34:473-87, vii. [DOI: 10.1016/j.iac.2014.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
41
|
van Wijk F, Nierkens S. Assessment of drug-induced immunotoxicity in animal models. DRUG DISCOVERY TODAY. TECHNOLOGIES 2014; 3:103-9. [PMID: 24980108 DOI: 10.1016/j.ddtec.2006.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the growing understanding that drugs might induce immune-mediated adverse reactions in patients, immunotoxicity testing of new pharmaceuticals has become an important topic in drug development. The nonclinical assessment of unexpected immune suppression is based on relatively well-standardized and validated assays and animal models. For the evaluation of direct immune stimulation few animal models are available, whilst the development of animal models to assess drug-induced hypersensitivity and in particular autoimmunity is in its infancy.:
Collapse
Affiliation(s)
- Femke van Wijk
- Institute for Risk Assessment Sciences, Department of Immunotoxicology, Utrecht University, Utrecht, The Netherlands
| | - Stefan Nierkens
- Nijmegen Centre for Molecular Life Sciences, Department of Tumorimmunology, Nijmegen Medical Centre, Nijmegen, The Netherlands.
| |
Collapse
|
42
|
Earnshaw CJ, Pecaric-Petkovic T, Park BK, Naisbitt DJ. T cell responses to drugs and drug metabolites. EXPERIENTIA SUPPLEMENTUM (2012) 2014; 104:137-63. [PMID: 24214623 DOI: 10.1007/978-3-0348-0726-5_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Understanding the chemical mechanisms by which drugs and drug metabolites interact with cells of the immune system is pivotal to our knowledge of drug hypersensitivity as a whole.In this chapter, we will discuss the currently accepted mechanisms where there is scientific and clinical evidence to support the ways in which drugs and their metabolites interact with T cells. We will also discuss bioanalytical platforms, such as mass spectrometry, and in vitro test assays such as the lymphocyte transformation test that can be used to study drug hypersensitivity; the combination of such techniques can be used to relate the chemistry of drug antigen formation to immune function. Ab initio T cell priming assays are also discussed with respect to predicting the potential of a drug to cause hypersensitivity reactions in humans in relation to the chemistry of the drug and its ability to form haptens, antigens and immunogens in patients.
Collapse
Affiliation(s)
- C J Earnshaw
- Department of Molecular and Clinical Pharmacology, Medical Research Council Centre for Drug Safety Science, University of Liverpool, Sherrington Building, Ahston Street, Liverpool, L69 3GE, UK,
| | | | | | | |
Collapse
|
43
|
Dermatologic Side Effects of Psychotropic Medications. PSYCHOSOMATICS 2014; 55:1-20. [DOI: 10.1016/j.psym.2013.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 12/21/2022]
|
44
|
Affiliation(s)
- Colin Bigham
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Perth, Australia.
| | | |
Collapse
|
45
|
Drug reaction with eosinophilia and systemic symptoms: A drug-induced hypersensitivity syndrome with variable clinical features. DERMATOL SIN 2013. [DOI: 10.1016/j.dsi.2013.09.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
46
|
Valeyrie-Allanore L, Ingen-Housz-Oro S, Chosidow O, Wolkenstein P. French referral center management of Stevens–Johnson syndrome/toxic epidermal necrolysis. DERMATOL SIN 2013. [DOI: 10.1016/j.dsi.2013.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
47
|
Advances in the Diagnosis of Drug Eruptions. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
|
48
|
de la Torre C, Suh Oh H. Novedades en el diagnóstico de las toxicodermias. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:782-8. [DOI: 10.1016/j.ad.2012.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 11/13/2012] [Accepted: 11/24/2012] [Indexed: 11/26/2022] Open
|
49
|
Liippo J, Pummi K, Hohenthal U, Lammintausta K. Patch testing and sensitization to multiple drugs. Contact Dermatitis 2013; 69:296-302. [DOI: 10.1111/cod.12076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/21/2013] [Accepted: 02/09/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Jussi Liippo
- Department of Dermatology; Turku University Hospital; 20521 Turku Finland
| | - Kati Pummi
- Department of Dermatology; Turku University Hospital; 20521 Turku Finland
- Department of Pathology; Turku University Hospital; 20521 Turku Finland
| | - Ulla Hohenthal
- Department of Internal Medicine; Turku University Hospital; 20521 Turku Finland
| | - Kaija Lammintausta
- Department of Dermatology; Turku University Hospital; 20521 Turku Finland
| |
Collapse
|
50
|
Abstract
Cutaneous drug eruptions can range from an asymptomatic rash to a life-threatening emergency. Because of the high frequency, morbidity, and potential mortality associated with drug eruptions, patients with possible drug reactions should promptly be recognized, worked up, and treated. Drug reactions are common in the elderly population due to age-related alterations in metabolism, excretion of medications, and polypharmacy. This review discusses the epidemiology, pathogenesis, clinical presentation, diagnosis, and management of drug eruptions that providers commonly encounter in the care of the geriatric population. An algorithm for an approach to patients with a suspected drug eruption is presented.
Collapse
Affiliation(s)
- Ammar M Ahmed
- Department of Dermatology, University of Texas-Southwestern Medical Center-Austin Campus, University Medical Center Brackenridge, Seton Healthcare Family, 601 East 15th Street, CEC C2.443, Austin, TX 78701, USA.
| | | | | |
Collapse
|