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Roy Chowdhury S. Genital Ulcers Are Not Always Because of Sexually Transmitted Infections: A Case Report of an Unusual Presentation of Fixed Drug Eruption in a Pediatric Patient. J Pediatr Health Care 2024; 38:758-760. [PMID: 38260927 DOI: 10.1016/j.pedhc.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
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Chindhalore CA, Gupta AV, Dakhale GN, Srivastava A. Analysis of Cutaneous Adverse Drug Reactions (ADR) Reported at an ADR Monitoring Center of a Tertiary Care Teaching Institute in Central India. Cureus 2024; 16:e53706. [PMID: 38455795 PMCID: PMC10918304 DOI: 10.7759/cureus.53706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Background Cutaneous adverse drug reactions (ADRs) are among the most frequent ADRs. Knowledge of the pattern of cutaneous ADRs (CADRs) and causal drugs helps prevent and reduce the incidence of CADR, which in turn reduces the incidence of hospitalization and expenses for the patient. Objectives To analyze CADR according to demographic profile, morphological pattern, causative drugs, severity, and outcome in patients suffering from CADRs. Materials and methods Retrospective data analysis was conducted in the Adverse Drug Reaction Monitoring Centre (AMC) of the tertiary care teaching institute between February 2020 and September 2023 under the Pharmacovigilance Program of India (PvPI). All ADRs reported were analyzed based on the following parameters: total number of ADRs reported, number of CADRs, information related to demographic parameters, the clinical presentation of CADRs, and suspected medication. Causality assessment was done using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Severity was assessed using a modified Hartwig and Seigel scale. Results A total of 125 CADRs were analyzed. Considering the gender-wise distribution, 65 females and 60 males suffered from CADR. The most common drug category responsible for CADRs was antimicrobials (63.2%), followed by topical agents (12.8%). Maculopapular rash (33.6%) was the most common presenting symptom, followed by itching (27.2%). Few patients suffered from serious CADRs such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Conclusion A wide clinical spectrum of CADRs ranging from maculopapular rash to fixed-drug eruption to serious SJS was observed in our study. The most common causative agents for CADRs were antimicrobials, followed by topical agents and NSAIDs. For early diagnosis and management of CADRs, it is critical to have data on the potential cutaneous adverse effects of commonly used drugs, to educate the patients regarding common early symptoms of drug reactions (e.g., erythematous rash, edema, urticaria, mucosal erosions, itching, burning of skin, etc.), and to monitor the patient, especially during the start of therapy. To ease the burden of CADRs, a therapeutic plan of anticipating, avoiding, recognizing, and responding to ADRs should be implemented.
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Affiliation(s)
| | - Ashish V Gupta
- Pharmacology, Nandkumar Singh Chauhan Government Medical College, Khandwa, Khandawa, IND
| | - Ganesh N Dakhale
- Pharmacology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Ankita Srivastava
- Dermatology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
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Huong PT, Ha TN, Nhu TTQ, Nga NTH, Anh NH, Hoa VD, Binh NQ, Anh NH. Allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: Signal detection and preventability from Vietnam National pharmacovigilance database. J Clin Pharm Ther 2022; 47:2014-2019. [PMID: 35848069 DOI: 10.1111/jcpt.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Allopurinol, the first-line medication for hyperuricemia is well-known for its association with severe cutaneous adverse reactions, especially Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). In the current study, we analysed the Vietnamese spontaneous reporting database to identify signals and preventability of allopurinol-induced SJS/TEN in Vietnam from 2010 to 2019. METHODS Signal generation was assessed using the case/non-case method. Reporting odds ratios (RORs) and 95% confidence intervals (95% CI) were calculated. RESULTS Among 72,822 spontaneous ADR reports submitted to the Vietnam National Drug Information and Adverse Drug Reaction Monitoring Centre, 392 reports were on SJS/TEN, of which, 65 cases (16.6%) were related to allopurinol. The signals of allopurinol-induced SJS/TEN in Vietnam started in 2014 (ROR of 3.531, 95% CI: 1.830-6.810) and annually increased until 2019 (ROR of 11.923, 95% CI: 8.508-16.710). The preventability assessment showed that no allopurinol-induced SJS/TEN case was definitely unpreventable. 61.6% of the SJS/TEN cases were avoidable because they were associated with inappropriate prescribing such as unapproved indications, too high initial dose and even rechallenging in patients with a history of allopurinol allergy. WHAT IS NEW AND CONCLUSION The signals of allopurinol-induced SJS/TEN in Vietnam started in 2014 and annually increased until 2019. Our first report specifically focusing on the ADR preventability of allopurinol showed that correction of medical errors relating to prescription could prevent more than 60% of SJS/TEN cases in Vietnamese allopurinol users. This is a feasible and practical solution, provided that there would be a systematic change in both healthcare systems and public awareness.
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Affiliation(s)
- Phung Thanh Huong
- Department of Biochemistry, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Tran Ngan Ha
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Tran Thi Quynh Nhu
- Department of Biochemistry, Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Nguyen Hoang Anh
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Vu Dinh Hoa
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Nguyen Quoc Binh
- The Regional Centre of Drug Information and Adverse Drug Reaction Monitoring in Ho Chi Minh City, Choray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Anh
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam.,Clinical Pharmacy - Drug Information Unit, Department of Pharmacy, Bach Mai Hospital, Hanoi, Vietnam
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Khalili M, Sharifi H, Mesgarpour B, Kheirandish M, Olsson S, Javidnikou N, Haghdoost AA. Evaluation of Pharmacovigilance System in Iran. Int J Health Policy Manag 2022; 11:990-1000. [PMID: 33590736 PMCID: PMC9808195 DOI: 10.34172/ijhpm.2020.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evaluating a pharmacovigilance system helps identify its deficiencies and could facilitate measures to remedy and improve the quantity and quality of adverse drug reaction (ADR) reports and other opportunities for pharmacovigilance systems strengthening. This study aimed to evaluate the status of pharmacovigilance in Iran using the World Health Organization (WHO) pharmacovigilance indicators with the prospect of identifying the gaps and areas for improvement. METHODS This study was conducted in 2 parts. The first part included a secondary analysis of the national data obtained from the Iranian National Pharmacovigilance Center (PVC) using a structured data collection form based on WHO core pharmacovigilance indicators. In the second part, a 3-month prospective study was carried out to investigate 2 outcome indicators, ie, length of stay and costs of medicine-related hospitalization in all patients of 2 main referral hospitals in the southeast and north of Iran. RESULTS Iran has a PVC with national policy, trained staff, and a statutory budget. In 2017, the number of ADR reports was 15.0 per 100 000 population, and 262 signals were detected during the preceding 5 years. The average length of stay and costs of medicine-related hospitalization were 5 days and US$817.2 in Afzalipour hospital and 6.6 days and US$306.7 in Razi hospital, respectively. The status of pharmacovigilance in the Iranian public health programs (PHPs) is unknown, and most of the indicators could not be assessed. CONCLUSION A robust pharmacovigilance system is a pivotal part of the overall medicines regulatory system. The Iranian pharmacovigilance system has relatively the proper structural condition. Though the underreporting of ADRs, especially medicine-related deaths, is an important issue, and some indicators' status was unclear. The Iranian pharmacovigilance program requires a higher prioritization, particularly in the PHPs, a greater allocation of resources, and cross-sectoral cooperation to bolster and achieve the pharmacovigilance objectives.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development, Tehran, Iran
| | - Mehrnaz Kheirandish
- Department for Assessment and Control of Prescribing and Use of Medicines and Health Products, Food and Drug Administration, Tehran, Iran
| | - Sten Olsson
- International Society of Pharmacovigilance, London, UK
- Pharmacovigilance Consulting, Uppsala, Sweden
| | | | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Ng WL, Lim KS, Hariraj V, Lee SC, Wo WK, Ramli A, Lai PSM, Fong SL, Lim JR. Incidence of allopurinol-induced severe cutaneous adverse drug reaction in Malaysia. Br J Clin Pharmacol 2022; 88:3782-3788. [PMID: 35318720 DOI: 10.1111/bcp.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS Allopurinol is known to cause severe cutaneous adverse drug reactions (SCAR) in Malaysia. However, the incidence of allopurinol-induced SCAR is unknown. Therefore, we aimed to determine the incidence of allopurinol-induced SCAR in Malaysia over 5 years from 2015 to 2019. METHODS This retrospective analysis was done in collaboration with the National Pharmaceutical Regulatory Agency (NPRA). All allopurinol-induced adverse drug reaction cases reported to NPRA from 2015 to 2019 were extracted. Allopurinol-induced SCAR cases were identified and the incidence over the 5 years was calculated. RESULTS Incidence of allopurinol-induced SCAR averaged at 2.5 cases per 1000 new users over the 5-year period, with a reducing trend from 3.2 per 1000 new users in 2015 to 2.25 per 1000 in 2019; despite the increasing number of adverse drug reaction cases being reported over the years. Stevens-Johnson syndrome was the commonest form of allopurinol-induced SCAR reported, at 143 cases (46.8% of total SCAR reported). Among Malaysia's 3 main ethnicities, the Chinese had the highest percentages of allopurinol-induced SCAR when compared to the Bumiputera and Indians (3.18 × 10-4 %). CONCLUSION The estimated incidence of allopurinol-induced SCAR in Malaysia from 2015 to 2019 was 2.5 cases per 1000 new users. This figure is consistent with the incidence reported in other Asian countries, namely Taiwan and Thailand.
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Affiliation(s)
- Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vidhya Hariraj
- Pharmacovigilance Section, Centre of Compliance and Quality Control, National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health, Malaysia
| | - Sing Chet Lee
- Pharmacovigilance Section, Centre of Compliance and Quality Control, National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health, Malaysia
| | - Wee Kee Wo
- Pharmacovigilance Section, Centre of Compliance and Quality Control, National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health, Malaysia
| | - Azuana Ramli
- Pharmacovigilance Section, Centre of Compliance and Quality Control, National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jing Ran Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Mitamura Y, Schulz D, Oro S, Li N, Kolm I, Lang C, Ziadlou R, Tan G, Bodenmiller B, Steiger P, Marzano A, de Prost N, Caudin O, Levesque M, Stoffel C, Schmid‐Grendelmeier P, Maverakis E, Akdis CA, Brüggen M. Cutaneous and systemic hyperinflammation drives maculopapular drug exanthema in severely ill COVID-19 patients. Allergy 2022; 77:595-608. [PMID: 34157151 PMCID: PMC8441838 DOI: 10.1111/all.14983] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) has been associated with cutaneous findings, some being the result of drug hypersensitivity reactions such as maculopapular drug rashes (MDR). The aim of this study was to investigate whether COVID-19 may impact the development of the MDR. METHODS Blood and skin samples from COVID-19 patients (based on a positive nasopharyngeal PCR) suffering from MDR (COVID-MDR), healthy controls, non-COVID-19-related patients with drug rash with eosinophilia and systemic symptoms (DRESS), and MDR were analyzed. We utilized imaging mass cytometry (IMC) to characterize the cellular infiltrate in skin biopsies. Furthermore, RNA sequencing transcriptome of skin biopsy samples and high-throughput multiplexed proteomic profiling of serum were performed. RESULTS IMC revealed by clustering analyses a more prominent, phenotypically shifted cytotoxic CD8+ T cell population and highly activated monocyte/macrophage (Mo/Mac) clusters in COVID-MDR. The RNA sequencing transcriptome demonstrated a more robust cytotoxic response in COVID-MDR skin. However, severe acute respiratory syndrome coronavirus 2 was not detected in skin biopsies at the time point of MDR diagnosis. Serum proteomic profiling of COVID-MDR patients revealed upregulation of various inflammatory mediators (IL-4, IL-5, IL-6, TNF, and IFN-γ), eosinophil and Mo/Mac -attracting chemokines (MCP-2, MCP-3, MCP-4 and CCL11). Proteomics analyses demonstrated a massive systemic cytokine storm in COVID-MDR compared with the relatively milder cytokine storm observed in DRESS, while MDR did not exhibit such features. CONCLUSION A systemic cytokine storm may promote activation of Mo/Mac and cytotoxic CD8+ T cells in severe COVID-19 patients, which in turn may impact the development of MDR.
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Affiliation(s)
| | - Daniel Schulz
- Institute for Molecular Health SciencesETH ZurichZurichSwitzerland
- Department of Quantitative BiomedicineUniversity of ZurichZurichSwitzerland
| | - Saskia Oro
- Department of DermatologyHenri Mondor HospitalParisFrance
| | - Nick Li
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
| | - Isabel Kolm
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
| | - Claudia Lang
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
| | - Reihane Ziadlou
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
| | - Ge Tan
- Swiss Institute for Allergy Research (SIAF) DavosDavosSwitzerland
| | - Bernd Bodenmiller
- Institute for Molecular Health SciencesETH ZurichZurichSwitzerland
- Department of Quantitative BiomedicineUniversity of ZurichZurichSwitzerland
| | - Peter Steiger
- Faculty of MedicineUniversity ZurichZurichSwitzerland
- Department of Intensive Care MedicineUniversity Hospital ZurichZurichSwitzerland
| | - Angelo Marzano
- Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | | | - Olivier Caudin
- Department of DermatologyHenri Mondor HospitalParisFrance
| | - Mitchell Levesque
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
| | - Corinne Stoffel
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
| | - Peter Schmid‐Grendelmeier
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
- Christine Kühne‐Center for Allergy Research and EducationDavosSwitzerland
| | - Emanual Maverakis
- Department of DermatologyUniversity of California, DavisSacramentoCAUSA
| | - Cezmi A. Akdis
- Swiss Institute for Allergy Research (SIAF) DavosDavosSwitzerland
- Christine Kühne‐Center for Allergy Research and EducationDavosSwitzerland
| | - Marie‐Charlotte Brüggen
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
- Faculty of MedicineUniversity ZurichZurichSwitzerland
- Christine Kühne‐Center for Allergy Research and EducationDavosSwitzerland
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Khalili M, Mesgarpour B, Sharifi H, Golozar A, Haghdoost AA. Estimation of adverse drug reaction reporting in Iran: Correction for underreporting. Pharmacoepidemiol Drug Saf 2021; 30:1101-1114. [PMID: 33772938 DOI: 10.1002/pds.5235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
PROPOSE Underreporting of Adverse Drug Reactions (ADRs) reduces the sensitivity of pharmacovigilance systems. We described ADR reporting and its trend from 1999 to 2017 and estimated the ADR underreporting in the Iranian Pharmacovigilance Center. METHODS We expressed the number of ADR reporting per inhabitants and admissions and their possible trends. Finally, ADR underreporting percentages were estimated by three approaches: prospective studies, literature review, stratification of the country; and the trend of the proportion of ADR per inhabitants was corrected. RESULTS The proportion of ADR reporting was 15.3 per 100 000 inhabitants (95% CI: 15.2, 15.8) and 10.0 per 100 000 admissions (95% CI: 9.8, 10.2) in 2017, and its trend was increasing with 16.3% average change per annum during 19 years. The median of estimated percentages of underreporting was 76.0% (IQR: 64.32-81.35). After the correction, the mean proportion of ADR reporting for 19 years reached from 5.87 to 10.33 per 100 000 inhabitants. CONCLUSIONS The trend of ADRs reporting has been increasing over the 19 years but is still low. This study showed a considerable underreporting of ADR, and about one of four detected ADRs were reported to the pharmacovigilance center from 1999 to 2017.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Mesgarpour
- Department of Public and International Affairs, National Institute for Medical Research Development, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Hung CT, Chen YH, Hung TL, Chen HC, Shih JH, Chiao YJ, Lin LC. Cutaneous adverse drug reactions in a tertiary hospital in Taipei, Taiwan, in 2018. JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmedsci.jmedsci_172_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Singh SK, Bohara A, Rai T. Comparison of Sensitivities of Skin Prick and Intradermal Tests with Oral Rechallenge Test: A Prospective Interventional Hospital-Based Study. Indian J Dermatol 2021; 66:55-59. [PMID: 33911294 PMCID: PMC8061478 DOI: 10.4103/ijd.ijd_554_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Identification of culprit drug causing adverse cutaneous drug reactions may not be possible clinically due to the intake of more than one drug. Aim: To compare the sensitivity of skin tests with gold standard oral rechallenge test to detect adverse cutaneous drug reactions. Materials and Methods: This is a prospective interventional hospital-based study of patients with adverse cutaneous drug reactions attending the outpatient department of dermatology and venereology at a tertiary care center over a 12-month period. Skin prick tests, intradermal tests, and oral rechallenge tests were performed in these patients and their sensitivities were compared. The data of quantitative nature is presented in mean and standard deviation, and categorical variables are presented in number and percentage. The sensitivity of skin tests is compared with the gold standard oral rechallenge test. Results: A total of 49 patients with adverse cutaneous drug reactions were evaluated. Clinical spectrum of adverse cutaneous drug reactions ranged from mild to severe, with fixed drug eruption being the commonest (55.1%) followed by maculopapular exanthem (32.7%). The highest incidence was with fluoroquinolones (43.8%) followed by nonsteroidal anti-inflammatory drugs. Fluoroquinolones were the major cause of fixed drug eruption followed by nonsteroidal anti-inflammatory drugs. The sensitivity of skin prick test and intradermal tests were 49% and 73%, respectively and the difference was highly significant (P < 0.001). The difference in sensitivity in skin prick test versus oral rechallenge test and intradermal test versus oral rechallenge test was also highly significant (P < 0.001). Limitations: Small sample size was a major limitation. Histopathological examinations and human leukocyte antigen associations could not be done. Conclusion: Predominant causative drugs were fluoroquinolones followed by nonsteroidal anti-inflammatory drugs. Sensitivities of skin prick test and intradermal test were quite good and these skin tests should be performed before oral rechallenge test in cases of adverse cutaneous drug reactions.
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Affiliation(s)
- Satyendra K Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ayushi Bohara
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tulika Rai
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Nasso C, Mecchio A, Rottura M, Valenzise M, Menniti-Ippolito F, Cutroneo PM, Squadrito V, Squadrito F, Pallio G, Irrera N, Arcoraci V, Altavilla D. A 7-Years Active Pharmacovigilance Study of Adverse Drug Reactions Causing Children Admission to a Pediatric Emergency Department in Sicily. Front Pharmacol 2020; 11:1090. [PMID: 32765282 PMCID: PMC7379477 DOI: 10.3389/fphar.2020.01090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
Children represent one of the most susceptible groups to adverse drug reactions (ADRs), as a consequence of physiological growth and maturation of different organ systems. The aim of this study was to characterize the frequency, preventability and seriousness of ADRs recorded in the Pediatric Emergency Department (ED) of the University hospital of Messina, in Sicily. All the suspected adverse reactions to drugs and vaccines collected from 2012 to 2018 were selected and then analyzed. Only adverse drug reactions (ADRs) with a probable or possible causality assessment were included, according to the Naranjo Algorithm and the World Health Organization criteria; the preventability assessment using Schumock and Thornton criteria was also carried out. The Medical Dictionary for Regulatory Activities (MedDRA) was used to group ADRs. Of 75,935 admissions to the Pediatric ED, 120 were due to suspected ADRs. The rate of hospital admission due to ADRs (75.8%) was significantly greater than that of patients without ADRs (11.9%). Among pediatric patients with ADRs the median (Q1–Q3) age was 29.5 (12–73.25) months. Most of ADRs were observed in infants and children (43.3% and 41.7%, respectively vs adolescents, 15%). In addition, in children with ADRs, females [41 (14–105)] were older than males [23 (11–45)] (p=0.044). Most adverse reactions were serious (75.8%) and 20.8% were preventable or probably preventable; however, the majority of serious ADRs (93.4%) resulted without sequelae. The reactions were found to be as probable (54.2%) or possible (45.8%). Vaccines (n=63), antibacterials (n=31) and anti-inflammatory medicines (n=14) were the most frequently drugs involved. Organ toxicity mapping due to vaccines was general disorders and administration site conditions (65.1%), nervous disorders (50.2%), cutaneous disorders (35%), followed by gastrointestinal disorders (20.6%). Cutaneous disorders (76%) gastrointestinal (20.7%), general (15.5%), and nervous disorders (8.6%) were the organ toxicity mapping due to drugs. Active pharmacovigilance has an essential role in supporting the development of strategies aimed at intervention to reduce admissions due to ADRs. Our data suggest that ADRs represent the first cause of hospitalization to the Pediatric Emergency Department. Furthermore, according to the literature, vaccines and antibiotics are the most frequent cause of adverse drug reactions in children.
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Affiliation(s)
- Chiara Nasso
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Mecchio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | | | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Center, Clinical Pharmacology Unit, University Hospital of Messina, Messina, Italy
| | - Violetta Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenica Altavilla
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Zhang H, Kang E, Ham YE, Chang JW. Disability and self-reported adverse drug events among patients with chronic diseases. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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