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Godfrey H, Jedlowski P, Thiede R. Medication Associations With Severe Cutaneous Adverse Reactions: A Case/Non-Case Analysis Using the FDA Adverse Event Reporting System. J Cutan Med Surg 2024; 28:51-58. [PMID: 38189282 DOI: 10.1177/12034754231220931] [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] [Indexed: 01/09/2024]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) are potentially life-threatening severe cutaneous adverse reactions (SCARs). Although the classical causal agents of SCARs (antibiotics, anticonvulsants, nonsteroidal anti-inflammatory drugs, and allopurinol) are well characterized, there has been little update to this list to account for newly marketed medications. OBJECTIVE To provide an updated and stratified list of medications with significant reporting odds ratios (RORs) of SCARs. METHODS A case/non-case analysis using the United States FDA Adverse Event Reporting System was performed. RESULTS As expected, the prototypical medication classes made up the majority of reported cases of SJS, TEN, AGEP, and DRESS (77%, 64%, 75%, and 72%, respectively). In addition, several infrequently or previously undescribed classes/medications implicated in SCARs were identified to have significant ROR signals, including acetylcysteine, anticoagulants, diuretics, immunotherapies, proton pump inhibitors, antivirals, and antifungals. Among these reported for SJS were acetylcysteine (ROR: 64.38) and fluconazole (ROR: 17.13). For TEN, we identified furosemide (ROR: 26.32), spironolactone (ROR: 14.45), fluconazole (ROR: 30.21), amphotericin B (39.06), and acetylcysteine (ROR: 93.12). For AGEP, we identified acyclovir (ROR: 61.72), valacyclovir (ROR: 30.76), and enoxaparin (ROR: 27.37). For DRESS, we identified vemurafenib (ROR: 17.35), acyclovir (ROR: 30.63), abacavir (ROR: 26.62), raltegravir (ROR: 23.27), and valacyclovir (ROR: 21.77) to have strong reporting odds. CONCLUSION Our analysis provides an updated tool for physicians to reference when identifying suspected SCARs and a basis for future studies to investigate atypical medication causality.
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Affiliation(s)
- Hannah Godfrey
- University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Patrick Jedlowski
- Division of Dermatology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Rebecca Thiede
- Division of Dermatology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
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2
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Kamat A, McGrath M, Weyand A. Enoxaparin-induced DRESS syndrome in a pediatric patient. Pediatr Blood Cancer 2023; 70:e30622. [PMID: 37580897 DOI: 10.1002/pbc.30622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Aarti Kamat
- Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA
- Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Mary McGrath
- Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA
- Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Angela Weyand
- Department of Pediatrics, University of Michigan Medicine Medical School, Ann Arbor, Michigan, USA
- Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
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3
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Gosnell H, Stein A, Vanegas Acosta DE. Postoperative fever secondary to enoxaparin usage with pork allergy. BMJ Case Rep 2022; 15:e246904. [PMID: 34996770 PMCID: PMC8744102 DOI: 10.1136/bcr-2021-246904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/04/2022] Open
Abstract
Postoperative fevers are common in hospitalised patients and warrant workup beyond the early post-op period. A 50-year-old man was admitted after sustaining a tibial plateau fracture. Fevers began 3 days after external fixation and persisted through a second surgery despite initial negative workup. Careful review of medications revealed enoxaparin as the instigating agent of a febrile drug reaction, and the fevers resolved after discontinuing the drug. On further questioning, it was discovered the patient had an allergy to pork, from which the main components of enoxaparin are typically derived. To our knowledge, this is the first reported enoxaparin-induced fever in the setting of a pork allergy. Enoxaparin-induced fevers should be considered in patients with unexplained post-op fever. Our case demonstrates the importance of analysing newly administered medications. Simple detailed history may significantly reduce patient morbidity and help to broaden differentials during investigation.
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Affiliation(s)
- Heather Gosnell
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Andrew Stein
- College of Medicine, University of Florida, Gainesville, Florida, USA
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KUBAT E, GÜRPINAR A, ERTUĞRUL G, IŞIK H, KARASOY D, ONUR MA. Enoksaparin sodyum subkutan fibroblast için tam olarak güvenli midir?: Bir hücre kültürü çalışması. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.822679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Assier H, Gener G, Chosidow O, Wolkenstein P, Ingen-Housz-Oro S. Acute generalized exanthematous pustulosis induced by enoxaparin: 2 cases. Contact Dermatitis 2020; 84:280-282. [PMID: 33131094 DOI: 10.1111/cod.13734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Haudrey Assier
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Gwendeline Gener
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Olivier Chosidow
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
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Gelincik A, Brockow K, Çelik GE, Doña I, Mayorga C, Romano A, Soyer Ö, Atanaskovic‐Markovic M, Barbaud A, Torres MJ. Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper. Allergy 2020; 75:2775-2793. [PMID: 32511784 PMCID: PMC7300843 DOI: 10.1111/all.14439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID-19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off-label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings together all the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off-label drugs and highlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactions in the course of the disease.
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Affiliation(s)
- Aslı Gelincik
- Department of Internal Medicine Division of Immunology and Allergic Diseases Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Gülfem E. Çelik
- Department of Chest Diseases Division of Immunology and Allergy Ankara University School of Medicine Ankara Turkey
| | - Inmaculada Doña
- Allergy Unit Hospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
| | - Cristobalina Mayorga
- Research Laboratory IBIMA‐Regional University Hospital of Malaga‐UMA‐ARADyAL Malaga Spain
| | - Antonino Romano
- IRCCS Oasi Maria S.S. Troina Italy
- Fondazione Mediterranea G.B. Morgagni Catania Italy
| | - Özge Soyer
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | | | - Annick Barbaud
- Department of Dermatology and Allergology, Tenon Hospital (AP‐HP) Sorbonne Universities, Pierre et Marie Curie University Paris France
- Institut Pierre Louis d’Epidémiologie et de Santé Publique AP‐HP Sorbonne Université Paris France
| | - Maria Jose Torres
- Allergy Unit Regional University Hospital of Malaga‐IBIMA‐UMA‐BIONAND‐ARADyAL Malaga Spain
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Al-Attar M, De Santis M, Massarotti M. DRESS syndrome in response to Denosumab: First documented case report. Bone Rep 2020; 12:100239. [PMID: 31890758 PMCID: PMC6933223 DOI: 10.1016/j.bonr.2019.100239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/01/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022] Open
Abstract
Denosumab is an antiresorptive drug targeting RANK ligand, currently licensed for postmenopausal and male osteoporosis, bone loss associated with hormone ablation in men with prostate cancer and with systemic glucocorticoid treatment, and also used in oncology for the treatment of bone metastases and unresectable giant cell tumour of bone. When used for the treatment of osteoporosis or bone loss the drug is usually well-tolerated with non-specific musculoskeletal pain being the most common side effect. However denosumab has been associated with some dermatological manifestations including dermatitis, eczema, pruritus and, less commonly, cellulitis. All these side effects are generally mild and self-limiting. We hereby report the first documented case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome following denosumab administration. DRESS syndrome is an extremely rare but potentially life-threatening hypersensitivity reaction. The syndrome should be considered in patients who present with new rash, eosinophilia and systemic organ dysfunction, especially when associated with new medications. Notably it has been previously reported in patients with osteoporosis treated with strontium ranelate but it has never been linked to any other antiosteoporotic drugs. Since the clinical manifestations of DRESS syndrome can span over a period of several months the diagnosis can frequently be quite difficult and it can become even more challenging in people taking denosumab and other drugs given in period doses, as both clinicians and patients are less likely to link the symptoms to the medication. Better recognition of DRESS syndrome is therefore needed, as well as awareness of the possibility of this reaction to occur in patients taking denosumab.
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Affiliation(s)
- Mariam Al-Attar
- Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Ashton Road, Lancaster LA14RP, United Kingdom
| | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Marco Massarotti
- Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Ashton Road, Lancaster LA14RP, United Kingdom
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Ng QX, Seng C, Ho CYX, Yeo WS. Enoxaparin: A cause of postoperative fever? Med Hypotheses 2018; 121:47-48. [PMID: 30396488 DOI: 10.1016/j.mehy.2018.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/08/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
Enoxaparin (clexane) is a low-molecular-weight heparin commonly prescribed for the chemoprophylaxis of venous thromboembolism in postoperative hip or knee replacement or abdominal surgery patients. We herein report a case of persistent postoperative fever in a patient, likely due to enoxaparin use. Prompt resolution of the patient's fever was observed after discontinuation of subcutaneous enoxaparin for chemical thromboprophylaxis. Reliable incidence data are lacking. A comprehensive search of PubMed, MEDLINE and EMBASE databases, as well as grey literature, found only two prior single case reports on enoxaparin-related fever. The mechanism responsible for the febrile reaction is likely an idiosyncratic response. Enoxaparin is typically derived from bovine or porcine intestines and lungs, hence its potential to cause hypersensitivity reactions is perhaps unsurprising. Clinicians should be alert to this possibility.
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Affiliation(s)
- Qin Xiang Ng
- Singapore General Hospital, Outram Road, Singapore 169608, Singapore; MOH Holdings Pte Ltd, 1 Maritime Square, Singapore 099253, Singapore.
| | - Chusheng Seng
- Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | | | - Wee-Song Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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9
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Schadler ED, Joyce JC, Haugen RN. Postpartum eruption of enoxaparin-induced erythema multiforme. Clin Case Rep 2018; 6:1966-1969. [PMID: 30349708 PMCID: PMC6186885 DOI: 10.1002/ccr3.1752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022] Open
Abstract
Enoxaparin is a commonly used hospital medication and in rare instances may result in development of erythema multiforme. Management of these patients can be challenging. Physicians must maintain a high index of suspicion and consider the indication for enoxaparin therapy prior to withdrawal of the medication.
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Affiliation(s)
- Eric D. Schadler
- University of Chicago Pritzker School of MedicineChicagoIllinois
| | - Joel C. Joyce
- Division of DermatologyNorthShore University HealthSystemSkokieIllinois
| | - Reshma N. Haugen
- Division of DermatologyNorthShore University HealthSystemSkokieIllinois
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10
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Abstract
While peripheral or tissue eosinophilia may certainly characterize drug eruptions, this feature is hardly pathognomonic for a medication-induced etiology. While delayed drug hypersensitivity reactions with prominent eosinophilic recruitment have been typically classified as type IVb reactions, their pathophysiology is now known to be more complex. Eosinophilic drug reactions have a diversity of presentations and may be benign and self-limited to severe and life-threatening. The extent of clinical involvement is also heterogeneous, ranging from isolated peripheral eosinophilia or single organ involvement (most often the skin and lung) to systemic disease affecting multiple organs, classically exemplified by drug-reaction with eosinophilia and systemic symptoms (DRESS). The spectrum of implicated medications in the causation of DRESS is ever expanding, and multiple factors including drug metabolites, specific HLA alleles, herpes viruses, and immune system activation have been implicated in pathogenesis. Due to this complex interplay of various factors, diagnostic workup in terms of skin and laboratory testing has not been validated. Similarly, the lack of controlled trials limits treatment options. This review also describes other localized as well as systemic manifestations of eosinophilic disease induced by various medication classes, including their individual pathophysiology, diagnosis, and management. Given the multitude of clinical patterns associated with eosinophilic drug allergy, the diagnosis can be challenging. Considerable deficits in our knowledge of these presentations remain, but the potential for severe reactions should be borne in mind in order to facilitate diagnosis and institute appropriate management.
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Affiliation(s)
- Merin Kuruvilla
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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12
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Low-Molecular-Weight Heparins as Immunomodulators in Dermatology Practice. Am J Ther 2015; 23:e1911-e1917. [PMID: 25853237 DOI: 10.1097/mjt.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Low-molecular-weight heparins (LMWHs) have some effects on cell proliferation and inflammation beyond mere anticoagulation. They have been tried on treatment of a few dermatological disorders such as lichen planus, skin wound healing, recurrent aphtous stomatitis, chronic urticaria, and contact hypersensitivity. LMWHs are generally well-tolerated drugs, rarely can lead to severe reactions. In this article, we will review the novel indications of LMWHs in dermatology practice and common skin reactions associated with their use.
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Guillaume-Jugnot P, Bioul C, Horreau C, Kheloufi F, Secq V, Ebbo M, Jean-Pastor M, Brajon D, Harle J, Berbis P. Étonnant cas de DRESS syndrome induit à la daltéparine sodique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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