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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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Traineau H, Milpied B, Soria A, Assier H, Tetart F, Bernier C, Le Bouëdec MCF, Gener G, Kurihara F, Bauvin O, Delauney J, Amsler E, Bara C, Pelletier F, Valois A, Castelain F, de Risi Pugliese T, Hamelin A, Barbaud A. In Situ Patch Test and Repeated Open Application Test for Fixed Drug Eruption: A Multicenter Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:460-468. [PMID: 37863314 DOI: 10.1016/j.jaip.2023.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Few studies have evaluated allergy workup in fixed drug eruption (FDE) in a large population. OBJECTIVE To evaluate the sensitivity of a standardized allergy workup for diagnosing the cause of FDE, with a focus on in situ repeated open application tests (ROATs). METHODS In a retrospective multicenter study, we analyzed the practice of conducting a complete allergy workup for the etiological diagnosis of FDE. It consisted of 3 steps: in situ patch tests (PTs) for all cases except pure mucosal involvement, followed by in situ ROAT if in situ PT results were negative, and finally a drug challenge (DC). The in situ ROAT involved daily application of the suspected drug on a previously affected FDE site for 7 days. RESULTS Of 98 suspected FDE cases, 61 patients (median age 61 y; male-to-female ratio 1.8) with a complete allergy workup were included. In 4 cases, even the DC yielded negative results. Among the remaining 57 patients with a positive workup, implicated drugs included paracetamol (12 cases), β-lactams (11 cases), imidazoles (9 cases, including 5 with metronidazole), nonsteroidal anti-inflammatory drugs (8 cases), iodinated contrast media (4 cases), cotrimoxazole (3 cases), and various other drugs in 10 patients. The diagnosis was confirmed by in situ PT in 17 of 54 cases (31.5%), in situ ROAT in 14 of 40 cases (35%) (with 4 cases showing remote reactivation of FDE sites), and DC in 26 cases. CONCLUSIONS The sequential allergy workup involving successively in situ PT, in situ ROAT, and DC is a reliable and safe method for diagnosing the cause of FDE. In situ tests exhibited a sensitivity of over 50%.
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Affiliation(s)
- Hélène Traineau
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Brigitte Milpied
- Centre hospitalo-universitaire (CHU) de Bordeaux, Dermatology department, Saint André hospital, Bordeaux, France
| | - Angèle Soria
- Cimi-Paris Inserm 1135, AP-HP, Sorbonne University, Hôpital Tenon, Dermatology and allergology department, Paris, France
| | - Haudrey Assier
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | | | | | | | - Gwendeline Gener
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
| | - Flore Kurihara
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Juliette Delauney
- CHU d'Angers, Dermatology department, Centre hospitalier de Cholet, Angers, France
| | - Emmanuelle Amsler
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Corina Bara
- Dermatology department, Centre hospitalier du Mans, Le Mans, France
| | | | - Aude Valois
- Dermatology department, Hôpital d'instruction des armées Sainte Anne, Toulon, France
| | | | - Tullia de Risi Pugliese
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Aurore Hamelin
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Annick Barbaud
- Médecine Sorbonne Universiy, Dermatology and allergology department, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
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Habchane A, Bentabet F, Khatem S, Alioua A, Adali I, Manoudi F, Zaoui S. Carbamazepine-induced bullous fixed drug eruption: A case report. Therapie 2023:S0040-5957(23)00119-1. [PMID: 37806796 DOI: 10.1016/j.therap.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/26/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Amal Habchane
- Department of Pharmacology and Toxicology, Clinical Research Center, Mohammed VI University Hospital, 4000 Marrakesh, Morocco.
| | - Fadwa Bentabet
- Department of Psychiatry, Ibn Nafis Hospital, Mohamed VI University Hospital, 4000 Marrakech, Morocco
| | - Soukaina Khatem
- Department of Pharmacology and Toxicology, Clinical Research Center, Mohammed VI University Hospital, 4000 Marrakesh, Morocco
| | - Ayyoub Alioua
- Department of Pharmacology and Toxicology, Clinical Research Center, Mohammed VI University Hospital, 4000 Marrakesh, Morocco; Faculty of Medicine and Pharmacy, Science and Technology and Medical Sciences, Bioscience, and Health Laboratory, Cadi Ayyad University, 4000 Marrakech, Morocco
| | - Imane Adali
- Department of Psychiatry, Ibn Nafis Hospital, Mohamed VI University Hospital, 4000 Marrakech, Morocco
| | - Fatiha Manoudi
- Department of Psychiatry, Ibn Nafis Hospital, Mohamed VI University Hospital, 4000 Marrakech, Morocco
| | - Sanaa Zaoui
- Department of Pharmacology and Toxicology, Clinical Research Center, Mohammed VI University Hospital, 4000 Marrakesh, Morocco; Faculty of Medicine and Pharmacy, Bioscience and Health Laboratory, Cadi Ayyad University, 4000 Marrakesh, Morocco
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Barbaud A, Romano A. Skin Testing Approaches for Immediate and Delayed Hypersensitivity Reactions. Immunol Allergy Clin North Am 2022; 42:307-322. [DOI: 10.1016/j.iac.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Barbaud A, Castagna J, Soria A. Skin Tests in The Work-Up of Cutaneous Adverse Drug Reactions: A Review and Update. Contact Dermatitis 2022; 86:344-356. [PMID: 35122269 DOI: 10.1111/cod.14063] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Julie Castagna
- AP-HP, Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Angèle Soria
- Sorbonne Université, INSERM 1135 Cimi-Paris, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Département de dermatologie et d'allergologie, 4 rue de la Chine, Paris
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Braesch C, Weill A, Gaudin O, Lebrun-Vignes B, Bernigaud C, Hua C, Ortonne N, Nakad L, Chambrin V, Chosidow O, Wolkenstein P, Thomas L, Assier H, Ingen-Housz-Oro S. Relapsing generalized bullous fixed drug eruption: A severe and avoidable cutaneous drug reaction. Three case reports. Therapie 2021; 77:378-381. [PMID: 33962797 DOI: 10.1016/j.therap.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Clément Braesch
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Amandine Weill
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Olivier Gaudin
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Reference Center for Toxic Bullous Diseases and Severe Drug Reactions-TOXIBUL, 94000 Créteil, France.
| | - Bénédicte Lebrun-Vignes
- Regional Pharmacovigilance Center, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France; Department of Clinical Immunology, Antoine-Béclère Hospital, 92140 Clamart, France
| | - Charlotte Bernigaud
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Université Paris Est Créteil Val de Marne, UPEC, 94000 Créteil, France
| | - Camille Hua
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Nicolas Ortonne
- Université Paris Est Créteil Val de Marne, UPEC, 94000 Créteil, France; Pathology Department, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
| | - Lionel Nakad
- Emergency Department, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
| | - Véronique Chambrin
- Department of Clinical Immunology, Antoine-Béclère Hospital, 92140 Clamart, France
| | - Olivier Chosidow
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Reference Center for Toxic Bullous Diseases and Severe Drug Reactions-TOXIBUL, 94000 Créteil, France; Université Paris Est Créteil Val de Marne, UPEC, 94000 Créteil, France
| | - Pierre Wolkenstein
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Reference Center for Toxic Bullous Diseases and Severe Drug Reactions-TOXIBUL, 94000 Créteil, France; Université Paris Est Créteil Val de Marne, UPEC, 94000 Créteil, France
| | - Laure Thomas
- Pharmacovigilance Center, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
| | - Haudrey Assier
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Saskia Ingen-Housz-Oro
- Dermatology department, AP-HP, Henri Mondor Hospital, 51, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Reference Center for Toxic Bullous Diseases and Severe Drug Reactions-TOXIBUL, 94000 Créteil, France; EA 7379 EpidermE, UPEC, 94000 Créteil, France
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A case of fixed drug eruption induced by doxycycline, mimicking a symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). Therapie 2020; 75:511-513. [DOI: 10.1016/j.therap.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/22/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022]
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