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Matei I, Bettuzzi T, Weill A, Gener G, Hareth KB, Margaux F, Verlinde-Carvalho M, Paul M, Ingen-Housz-Oro S, Assier H. Patch tests in non-immediate cutaneous adverse drug reactions: Late readings on Day 4 is more sensitive than on Day 3. Contact Dermatitis 2024. [PMID: 39078104 DOI: 10.1111/cod.14654] [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: 04/03/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Patch tests (PTs) are recommended to identify the culprit drug in non-immediate cutaneous adverse drug reactions (NICADRs). We recently reported that, in patients with NICADRs, a unique reading of PTs at day (D)2 compared with an additional second late reading at D4 missed almost half (45.3%) of the positive PTs. OBJECTIVES To assess the change in sensitivity of the PT reading on D4 compared with the reading on D3. METHODS We performed a retrospective (July 2020-June 2023) monocentric study of patients who had PTs with two readings for a NICADR. We compared reading on D3 and the second reading on D4 for the suspected drug (primary outcome) and for the related drugs tested simultaneously (secondary outcome). RESULTS During the study period, 249 patients underwent patch testing with D3 and D4 readings. Regarding the primary outcome, the first reading at D3 was positive for 13.7% of patients, and the reading at D4 for 24.9% of patients (p < 0.0001). Regarding the secondary outcome, only 9.6% of patients had all their positive PT at D3 compared with 24.9% of patients at D4 (p < 0.0001). Considering the evaluated drug classes, no statistical difference was observed. However, we highlight that D3 reading detected all positive carbamazepine PTs (n = 3) while positive clindamycin PTs (n = 4) were identified only with the help of the second reading on D4. CONCLUSION This study showed that, an additional D4 reading compared with a single D3 reading enhanced the sensitivity of PTs to identify culprit drugs and related. Further studies should replicate these findings and evaluate the medico-economic balance and safety of a single reading of PTs on D4.
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Affiliation(s)
- Ilaria Matei
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Thomas Bettuzzi
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
- EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
| | - Amandine Weill
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Gwendeline Gener
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Kamar Bel Hareth
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Fleck Margaux
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | | | - Muriel Paul
- EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France
- Department of Pharmacy, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
- EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
| | - Haudrey Assier
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
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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.
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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.
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Médicaments responsables de toxidermie chez des enfants de phototype foncé à Dakar. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2023.103304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Zaouak A, Ben Salem F, Ben Jannet S, Hammami H, Fenniche S. Bullous fixed drug eruption: A potential diagnostic pitfall: a study of 18 cases. Therapie 2019; 74:527-530. [DOI: 10.1016/j.therap.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/20/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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Broche C, Pralong P, Gil H, Yahiaoui N, Mousseau M, Chatain C, Jacquier JP, Charles J, Leccia MT. Fixed drug eruption caused by fulvestrant confirmed by skin tests: First case. Contact Dermatitis 2018; 80:184-186. [PMID: 30461027 DOI: 10.1111/cod.13161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Clémentine Broche
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pauline Pralong
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Hugo Gil
- Anatomopathology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Nassima Yahiaoui
- Regional Pharmacovigilance, Addictovigilance Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Mireille Mousseau
- Oncology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Catharina Chatain
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Jean-Pierre Jacquier
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julie Charles
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Marie-Thérèse Leccia
- Dermatology, Allergology and Photobiology Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Barbaud A. Investigations allergologiques dans les érythèmes pigmentés fixes. Méthode recommandée par le groupe FISARD de la SFD. Ann Dermatol Venereol 2018; 145:210-213. [DOI: 10.1016/j.annder.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/04/2018] [Indexed: 12/01/2022]
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