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Chen YL, Tsai TY, Pan LY, Tsai YJ, Chen SY, Hsiao CH, Yeh LK, Tan HY, Chen HC, Hung KH, Quan W, Chen CB, Chung WH, Ma DHK. Ocular Manifestations and Outcomes in Children With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Comparison With Adult Patients. Am J Ophthalmol 2023; 256:108-117. [PMID: 37633318 DOI: 10.1016/j.ajo.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/16/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE To compare the clinical features and visual outcomes in children and adults with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). DESIGN Retrospective comparative case series. METHODS This retrospective study included 280 eyes of 140 patients (35 children and 105 adults) with SJS/TEN treated between 2010 and 2020. The primary outcome measures were the final best-corrected visual acuity (BCVA) and severity of dry eye. The secondary outcome measure was the medical and surgical therapies used. RESULTS Among 64 eyes of children recruited in the study, acute ocular involvement was found in 58 eyes (90.6%). The chronic score in pediatric patients was significantly higher than that in adult patients (P = .004). The use of antibiotics/nonsteroidal anti-inflammatory drugs (NSAIDs) and Mycoplasma infection were the more common etiologies in children. In all, 75% of eyes in children maintained a visual acuity of 20/40 or better at a mean follow-up time of 4.3 years. The severity of dryness was comparable between the child and adult groups. The proportion of eyes undergoing amniotic membrane and oral mucosa transplantation was significantly higher in children than in adults in the chronic stage, reflecting that children exhibit much more severe complications. CONCLUSIONS Although pediatric SJS/TEN patients have more severe ocular complications than adults, most children maintain long-term good vision. Early intervention and aggressive treatment help to preserve vision.
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Affiliation(s)
- Yueh-Ling Chen
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Ying Tsai
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Li-Yen Pan
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yueh-Ju Tsai
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Yi Chen
- Department of Ophthalmology (S.-Y.C.), Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ching-Hsi Hsiao
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lung-Kun Yeh
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Tan
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chi Chen
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Hung
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wuyong Quan
- Department of Ophthalmology (W.Q., D.H.-K.M.), Xiamen Chang Gung Hospital, Xiamen, China
| | - Chun-Bing Chen
- Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Drug Hypersensitivity Clinical and Research Center (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences (C.-B.C., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Xiamen Chang Gung Hospital, Xiamen, China
| | - Wen-Hung Chung
- Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Drug Hypersensitivity Clinical and Research Center (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences (C.-B.C., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Xiamen Chang Gung Hospital, Xiamen, China
| | - David Hui-Kang Ma
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (W.Q., D.H.-K.M.), Xiamen Chang Gung Hospital, Xiamen, China; Department of Chinese Medicine (D.H.-K.M.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering (D.H.-K.M.), Chang Gung Memorial Hospital, Linkou, Taiwan.
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Gubernot D, Menis M, Whitaker B. Background rates for severe cutaneous reactions in the US: Contextual support for safety assessment of COVID-19 vaccines and novel biologics. Vaccine 2023; 41:6922-6929. [PMID: 37891051 DOI: 10.1016/j.vaccine.2023.10.025] [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: 04/19/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
The global COVID-19 public health crisis has resulted in extraordinary collaboration to expeditiously develop vaccines and therapeutics. The safety of these biologics is closely monitored by the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Novel products may have limited safety data, and although serious medical outcomes associated with vaccination are rare, knowledge of background incidence rates of medical conditions in the US population puts reported adverse events (AEs) in perspective for further study. Although relatively minor vaccination skin reactions are common, rare instances of severe delayed hypersensitivity reactions such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome may occur. To aid in the assessment of these events, we performed a literature search in PubMed and Web of Science on the background incidence of EM, SJS, SJS/TEN, and TEN in the US population and on published reports of these conditions occurring post-vaccination. The US background annual incidence rates per million individuals of all ages ranged from 5.3 to 63.0 for SJS, from 0.4 to 5.0 for TEN, and from 0.8 to 1.6 for SJS/TEN. Since these conditions may overlap, some studies reported rates for EM/SJS/TEN combined, however we did not find studies with exclusive EM incidence rates. The published literature, including studies of reports submitted to the FDA/CDC Vaccine Adverse Event Reporting System (VAERS), describes post-vaccination EM, SJS, SJS/TEN and/or TEN as rare occurrences. The vaccines most frequently associated with these conditions were measles, mumps, and rubella; diphtheria, tetanus, and pertussis; and varicella. The majority of VAERS reports of EM, SJS, SJS/TEN, or TEN occurred in children within 30 days of vaccination. This review summarizes background rates of these disorders in the general population and published AEs among vaccine recipients, to support safety surveillance of COVID-19 vaccines and other biologics.
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Affiliation(s)
- Diane Gubernot
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Mikhail Menis
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
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Morales-Ríos O, Cicero-Oneto C, García-Ruiz C, Villanueva-García D, Hernández-Hernández M, Olivar-López V, Jiménez-Juárez RN, Jasso-Gutiérrez L. Descriptive study of adverse drug reactions in a tertiary care pediatric hospital in México from 2014 to 2017. PLoS One 2020; 15:e0230576. [PMID: 32208451 PMCID: PMC7092985 DOI: 10.1371/journal.pone.0230576] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/03/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION In Pediatrics, adverse drug reactions (ADRs) affect morbidity and mortality. In Mexico, the characteristics of ADRs and suspect drugs have not been described in hospitalized children. OBJECTIVE To estimate the frequency of ADRs and describe them, as well as suspect drugs, in a tertiary care pediatric hospital in Mexico. METHODS A total of 1,649 Hospital Infantil de Mexico Federico Gómez ADR reports were analyzed. Completeness of the information was assessed, and ADRs severity and seriousness were assigned based on NOM-220-SSA1-2012, with causality being established according to the Naranjo algorithm. ADRs were classified with WHO Adverse Drug Reaction Terminology (WHO-ART). The drugs involved in ADRs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. Descriptive analysis was performed using the SPSS 20 statistical package. RESULTS Of all the reports, 5.8% lacked sufficient information for the analysis (grade 0). ADRs frequency ranged from 2.12% to 8.07%. ADRs occurred most commonly in children (56.9%), in the female gender (52%), in subjects with normal BMI Z-score (46.6%) and malnutrition (35.3%), diagnosed with neoplasms (72.2%) and in the Emergency Department (70.0%). ADRs were severe in 14.4% of cases, in 81.0% they were serious and 2.1% were classified as definite. Most common serious ADR was febrile neutropenia (44.5%). The 0.7% of patients recovering with sequelae; 1.1% died (with the medication being associated) and 70.3% were admitted to the hospital as a result of an ADR. Antineoplastic and immunomodulating agents were more commonly associated with serious ADRs. CONCLUSION ADRs affected morbidity and mortality, which is why strengthening pharmacovigilance programs in Mexican pediatric hospitals is necessary.
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Affiliation(s)
- Olga Morales-Ríos
- Clinical Research Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Carlo Cicero-Oneto
- Hematological Oncology Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Carlos García-Ruiz
- Clinical Research Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Dina Villanueva-García
- Neonatology Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - Víctor Olivar-López
- Emergency Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Rodolfo Norberto Jiménez-Juárez
- Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México
- Department of Pediatrics, Centro Médico Nacional La Raza, Infectious Diseases Hospital, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Luis Jasso-Gutiérrez
- Clinical Research Department, Hospital Infantil de México Federico Gómez, Ciudad de México, México
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Karnes JH, Miller MA, White KD, Konvinse KC, Pavlos RK, Redwood AJ, Peter JG, Lehloenya R, Mallal SA, Phillips EJ. Applications of Immunopharmacogenomics: Predicting, Preventing, and Understanding Immune-Mediated Adverse Drug Reactions. Annu Rev Pharmacol Toxicol 2018; 59:463-486. [PMID: 30134124 DOI: 10.1146/annurev-pharmtox-010818-021818] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adverse drug reactions (ADRs) are a significant health care burden. Immune-mediated adverse drug reactions (IM-ADRs) are responsible for one-fifth of ADRs but contribute a disproportionately high amount of that burden due to their severity. Variation in human leukocyte antigen ( HLA) genes has emerged as a potential preprescription screening strategy for the prevention of previously unpredictable IM-ADRs. Immunopharmacogenomics combines the disciplines of immunogenomics and pharmacogenomics and focuses on the effects of immune-specific variation on drug disposition and IM-ADRs. In this review, we present the latest evidence for HLA associations with IM-ADRs, ongoing research into biological mechanisms of IM-ADRs, and the translation of clinical actionable biomarkers for IM-ADRs, with a focus on T cell-mediated ADRs.
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Affiliation(s)
- Jason H Karnes
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona 85721, USA.,Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona 85724, USA.,Division of Pharmacogenomics, Center for Applied Genetics and Genomic Medicine (TCAG2M), Tucson, Arizona 85721, USA
| | - Matthew A Miller
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona 85721, USA
| | - Katie D White
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA;
| | - Katherine C Konvinse
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.,Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | - Rebecca K Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, Western Australia 6008, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia 6150, Australia
| | - Alec J Redwood
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia 6150, Australia
| | - Jonathan G Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town 7925, South Africa.,Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Rannakoe Lehloenya
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Simon A Mallal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA; .,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia 6150, Australia
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA; .,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia 6150, Australia
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Chronic Ocular Sequelae of Stevens-Johnson Syndrome in Children: Long-term Impact of Appropriate Therapy on Natural History of Disease. Am J Ophthalmol 2018; 189:17-28. [PMID: 29421293 DOI: 10.1016/j.ajo.2018.01.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the long-term ocular and visual morbidity in children with chronic sequelae of Stevens-Johnson syndrome (SJS) and visual outcomes of various management strategies. DESIGN Retrospective comparative case series. METHODS This study included 568 eyes of 284 children with SJS who presented between 1990 and 2015. Affected eyes received either conservative therapy (n = 440) or definitive management (n = 128), including lid margin mucous membrane grafting (MMG), prosthetic replacement of the ocular surface ecosystem (PROSE) contact lenses, allogeneic limbal transplantation, or keratoprosthesis using an algorithmic approach based on the severity of dryness and cause and extent of corneal damage. The primary outcome measure was best-corrected visual acuity (BCVA). RESULTS Two thirds of patients presented more than a year after acute SJS, 99% without prior amniotic membrane grafting, with low vision or blindness in 60% of eyes. Children 8 years or younger in age had significantly worse ocular and visual morbidity (P ≤ .037). At 5 years of follow-up, definitive therapy significantly altered the natural history of the disease by improving BCVA and preventing the development or progression of keratopathy, as compared to conservative therapy (P ≤ .002). In eyes with lid-related keratopathy, MMG was significantly more effective than PROSE, although both were significantly better than conservative therapy and the combination of MMG followed by PROSE provided the best results (P < .0001). CONCLUSION Children receiving suboptimal care during acute SJS presented later with severe ocular and visual morbidity. Timely therapy, particularly with PROSE and MMG in eyes with lid-related keratopathy, changed the natural course and helped in preserving and improving vision.
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White KD, Abe R, Ardern-Jones M, Beachkofsky T, Bouchard C, Carleton B, Chodosh J, Cibotti R, Davis R, Denny JC, Dodiuk-Gad RP, Ergen EN, Goldman JL, Holmes JH, Hung SI, Lacouture ME, Lehloenya RJ, Mallal S, Manolio TA, Micheletti RG, Mitchell CM, Mockenhaupt M, Ostrov DA, Pavlos R, Pirmohamed M, Pope E, Redwood A, Rosenbach M, Rosenblum MD, Roujeau JC, Saavedra AP, Saeed HN, Struewing JP, Sueki H, Sukasem C, Sung C, Trubiano JA, Weintraub J, Wheatley LM, Williams KB, Worley B, Chung WH, Shear NH, Phillips EJ. SJS/TEN 2017: Building Multidisciplinary Networks to Drive Science and Translation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:38-69. [PMID: 29310768 PMCID: PMC5857362 DOI: 10.1016/j.jaip.2017.11.023] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
Abstract
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a life-threatening, immunologically mediated, and usually drug-induced disease with a high burden to individuals, their families, and society with an annual incidence of 1 to 5 per 1,000,000. To effect significant reduction in short- and long-term morbidity and mortality, and advance clinical care and research, coordination of multiple medical, surgical, behavioral, and basic scientific disciplines is required. On March 2, 2017, an investigator-driven meeting was held immediately before the American Academy of Dermatology Annual meeting for the central purpose of assembling, for the first time in the United States, clinicians and scientists from multiple disciplines involved in SJS/TEN clinical care and basic science research. As a product of this meeting, this article summarizes the current state of knowledge and expert opinion related to SJS/TEN covering a broad spectrum of topics including epidemiology and pharmacogenomic networks; clinical management and complications; special populations such as pediatrics, the elderly, and pregnant women; regulatory issues and the electronic health record; new agents that cause SJS/TEN; pharmacogenomics and immunopathogenesis; and the patient perspective. Goals include the maintenance of a durable and productive multidisciplinary network that will significantly further scientific progress and translation into prevention, early diagnosis, and management of SJS/TEN.
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Affiliation(s)
- Katie D White
- Vanderbilt University Medical Center, Nashville, Tenn
| | - Riichiro Abe
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Thomas Beachkofsky
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Texas
| | | | - Bruce Carleton
- University of British Columbia, Vancouver, British Columbia, Canada; B.C. Children's Hospital, British Columbia, Vancouver, British Columbia, Canada
| | - James Chodosh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Ricardo Cibotti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md
| | - Robert Davis
- University of Tennessee Health Sciences, Memphis, Tenn
| | | | - Roni P Dodiuk-Gad
- Emek Medical Center, Technion-Institute of Technology, Afula, Israel; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - James H Holmes
- Wake Forest Baptist Medical Center, Winston-Salem, NC; Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | - Simon Mallal
- Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Md; F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md
| | | | | | - Maja Mockenhaupt
- Medical Center and Medical Faculty-University of Freiburg, Freiburg, Germany
| | | | - Rebecca Pavlos
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | | | - Elena Pope
- University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alec Redwood
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | | | | | | | | | - Hajirah N Saeed
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Jeffery P Struewing
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | | | | | - Cynthia Sung
- Duke-NUS Medical School, Singapore, Singapore; Health Sciences Authority, Singapore, Singapore
| | - Jason A Trubiano
- Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lisa M Wheatley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | | | - Neil H Shear
- Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
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Pavlos R, White KD, Wanjalla C, Mallal SA, Phillips EJ. Severe Delayed Drug Reactions: Role of Genetics and Viral Infections. Immunol Allergy Clin North Am 2017; 37:785-815. [PMID: 28965641 PMCID: PMC5702581 DOI: 10.1016/j.iac.2017.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adverse drug reactions (ADRs) are a significant source of patient morbidity and mortality and represent a major burden to health care systems and drug development. Up to 50% of such reactions are preventable. Although many ADRs can be predicted based on the on-target pharmacologic activity, ADRs arising from drug interactions with off-target receptors are recognized. Off-target ADRs include the immune-mediated ADRs (IM-ADRs) and pharmacologic drug effects. In this review, we discuss what is known about the immunogenetics and pathogenesis of IM-ADRs and the hypothesized role of heterologous immunity in the development of IM-ADRs.
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Affiliation(s)
- Rebecca Pavlos
- Institute for Immunology and Infectious Diseases, Murdoch University, 6150 Murdoch, Western Australia, Australia
| | - Katie D White
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Celestine Wanjalla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Simon A Mallal
- Institute for Immunology and Infectious Diseases, Murdoch University, 6150 Murdoch, Western Australia, Australia; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, 6150 Murdoch, Western Australia, Australia; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Gervasio KA, Wu AY. Diagnostic Delay and Amniotic Membrane Transplantation in a Child With Atypical Stevens-Johnson Syndrome. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e41-4. [PMID: 26301401 PMCID: PMC7584684 DOI: 10.3928/01913913-20150811-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/08/2015] [Indexed: 11/20/2022]
Abstract
A 4-year-old boy presented with a 6-day history of severe non-limbic-sparing conjunctivitis. Atypical Stevens-Johnson syndrome with a possible cause of Mycoplasma pneumoniae was suspected as the precipitant of the clinical symptoms. The patient recovered with amniotic membrane transplantation and intravenous immunoglobulin therapy despite an initial delay in diagnosis.
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Abe J, Mataki K, Umetsu R, Ueda N, Kato Y, Nakayama Y, Kinosada Y, Hara H, Inagaki N, Nakamura M. Stevens-Johnson syndrome and toxic epidermal necrolysis: the Food and Drug Administration adverse event reporting system, 2004-2013. Allergol Int 2015; 64:277-9. [PMID: 26117261 DOI: 10.1016/j.alit.2015.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/10/2014] [Accepted: 12/25/2014] [Indexed: 11/26/2022] Open
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10
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Chan EW, Liu KQL, Chui CSL, Sing CW, Wong LYL, Wong ICK. Adverse drug reactions - examples of detection of rare events using databases. Br J Clin Pharmacol 2015; 80:855-61. [PMID: 25060360 DOI: 10.1111/bcp.12474] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/21/2014] [Indexed: 11/27/2022] Open
Abstract
It is recognised that randomised controlled trials are not feasible for capturing rare adverse events. There is an increasing trend towards observational research methodologies using large population-based health databases. These databases offer more scope for adequate sample sizes, allowing for comprehensive patient characterisation and assessment of the associated factors. While direct causality cannot be established and confounders cannot be ignored, databases present an opportunity to explore and quantify rare events. The use of databases for the detection of rare adverse events in the following conditions, sudden death associated with attention deficit hyperactivity disorder (ADHD) treatment, retinal detachment associated with the use of fluoroquinolones and toxic epidermal necrolysis associated with drug exposure, are discussed as examples. In general, rare adverse events tend to have immediate and important clinical implications and may be life-threatening. An understanding of the causative factors is therefore important, in addition to the research methodologies and database platforms that enable the undertaking of the research.
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Affiliation(s)
- Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kirin Q L Liu
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Celine S L Chui
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chor-Wing Sing
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lisa Y L Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Prindaville B, Newell BD, Nopper AJ, Horii KA. Mycoplasma pneumonia--associated mucocutaneous disease in children: dilemmas in classification. Pediatr Dermatol 2014; 31:670-5. [PMID: 25424207 DOI: 10.1111/pde.12482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is controversy regarding precise definitions for Stevens-Johnson syndrome (SJS) and erythema multiforme (EM) major because of overlap in clinical presentations. SJS and EM major associated with Mycoplasma pneumoniae have been reported to occur in children, but Mycoplasma is more commonly reported with SJS. We sought to further characterize Mycoplasma-associated mucocutaneous disease. Through retrospective chart review over 10 years, six children hospitalized with a diagnosis of SJS who also tested positive for Mycoplasma infection were reviewed. Using documented physical examinations and photographs, diagnoses of SJS or EM major were retrospectively made based upon cutaneous lesional morphology employing the classification system proposed by Bastuji-Garin et al. The majority of patients were boys, with limited acral cutaneous lesions. All patients required prolonged hospitalization because of mucosal involvement and had good short-term outcomes. When the classification system was retrospectively applied, five of the six patients were reclassified with a diagnosis of EM major instead of SJS. Children with Mycoplasma-associated EM major and SJS in our small retrospective series appeared to have significant mucosal involvement but more limited cutaneous involvement with lesional morphology, which is more characteristic of EM major.
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Affiliation(s)
- Brea Prindaville
- Division of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
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