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Sekerel BE, Ilgun Gurel D, Sahiner UM, Soyer O, Kocaturk E. The many faces of pediatric urticaria. FRONTIERS IN ALLERGY 2023; 4:1267663. [PMID: 38026129 PMCID: PMC10655015 DOI: 10.3389/falgy.2023.1267663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Urticaria is a common disease that can affect individuals of all age groups, with approximately one-quarter of the population experiencing it at least once in their lifetime. Lesions characterized by erythema and itchy hives can appear anywhere on the body. These can vary in size ranging from millimeters to centimeters, and typically clear within 24 h. About 40% of patients with urticaria have accompanying angioedema, which involves localized deep tissue swelling. Urticaria usually occurs spontaneously and is classified into acute and chronic forms, with the latter referring to a condition that lasts for more than 6 weeks. The prevalence of chronic urticaria in the general population ranges from 0.5% to 5%, and it can either be inducible or spontaneous. The most common form of pediatric urticaria is acute and is usually self-limiting. However, a broad differential diagnosis should be considered in children with urticaria, particularly if they also have accompanying systemic complaints. Differential diagnoses of pediatric urticaria include chronic spontaneous urticaria, chronic inducible urticaria, serum sickness-like reaction, urticarial vasculitis, and mast cell disorders. Conditions that can mimic urticaria, including but not limited to cryopyrinopathies, hyper IgD syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis and Adenitis (PFAPA), Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPs), and Schnitzler syndrome should also be considered. The many faces of pediatric urticaria can be both easy and confusing. A pragmatic approach relies on clinical foresight and understanding the various forms of urticaria and their potential mimickers. This approach can pave the way for an accurate and optimized diagnostic approach in children with urticaria.
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Affiliation(s)
- Bulent Enis Sekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Deniz Ilgun Gurel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Umit Murat Sahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Emek Kocaturk
- Department of Allergology, Charite University School of Medicine, Berlin, Germany
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2
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Guarnieri KM, Xie SS, Courter JD, Liu C, Ruddy RM, Risma KA. Distinct Characteristics and Chronology of Amoxicillin-Associated Reactions in Pediatric Acute Care Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2951-2957.e3. [PMID: 35872212 DOI: 10.1016/j.jaip.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Amoxicillin-associated reactions (AARs) in children presenting as rashes are common, and recent data suggest that >90% tolerate amoxicillin on re-exposure. However, additional data would help pediatricians and allergists gain confidence in referring and testing children who experienced systemic symptoms perceived as "worrisome," thus leading to urgent medical evaluations. By characterizing the entire spectrum of AAR symptoms in pediatric patients presenting to emergency department (ED)/urgent care (UC) settings, we sought to increase our diagnostic acumen to guide subsequent allergy evaluations. OBJECTIVE To fully characterize clinical features of rash and systemic symptoms in children presenting to the ED/UC with AARs. METHODS A retrospective chart review of children seen in the ED/UC from July 1, 2015, to June 30, 2017, was conducted. Clinical features, chronology, and seasonality were detailed, and cases were classified into 3 previously described AAR phenotypes: maculopapular exanthem (MPE), urticaria, and serum sickness-like reactions (SSLRs), if they experienced joint symptoms. RESULTS Children (n = 668; median age: 1.8 years) presented to the ED/UC with urticaria (44%), MPE (36%), and SSLRs (11%) typically on days 7 to 10 of amoxicillin. Although children with SSLRs were more frequently treated with corticosteroids (28%, P < .0001) and exhibited higher rates of "worrisome" features (fever, angioedema, or gastrointestinal symptoms; 73%, P < .0001), delayed-onset systemic symptoms were identified frequently in all 3 groups. ED/UC reutilization was unexpectedly high with 66 children (10%) returning to the ED/UC for re-evaluation. CONCLUSION "Worrisome" symptoms are common in children presenting to the ED/UC with AARs. Future studies are needed to determine the impact on subsequent referral and allergy testing.
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Affiliation(s)
- Katharine M Guarnieri
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susan S Xie
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua D Courter
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard M Ruddy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kimberly A Risma
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Güngörer V, Ertan K, Arslan Ş. Diagnosis that clinicians don't think of, serum sickness-like reaction. Pediatr Int 2022; 64:e14740. [PMID: 34676635 DOI: 10.1111/ped.14740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Vildan Güngörer
- Departments of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Kübra Ertan
- Departments of Pediatrics, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Şükrü Arslan
- Departments of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
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Barootes HC, Peebles ER, Matsui D, Rieder M, Abuzgaia A, Mohammed JA. Severe Generalized Bullous Fixed Drug Eruption Treated with Cyclosporine: A Case Report and Literature Review. Case Rep Dermatol 2021; 13:154-163. [PMID: 33790760 PMCID: PMC7989674 DOI: 10.1159/000513469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/29/2020] [Indexed: 02/05/2023] Open
Abstract
Generalized bullous fixed drug eruptions (GBFDEs) are rare in the paediatric population. We present the case of a 7-year-old girl with GBFDE believed to be secondary to oral ibuprofen, who experienced rapid resolution of lesions and cessation of blistering with a 3-week course of oral cyclosporine. To the best of our knowledge, this is the first report of a paediatric case of GBFDE treated with cyclosporine. In our report, we review published cases of GBFDE in children, and all adult cases managed with cyclosporine.
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Affiliation(s)
- Hailey C Barootes
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Erin R Peebles
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Doreen Matsui
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael Rieder
- Department of Paediatrics, Division of Paediatric Clinical Pharmacology, Children's Hospital, London Health Sciences Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Awatif Abuzgaia
- Department of Paediatrics, Division of Paediatric Clinical Pharmacology, Children's Hospital, London Health Sciences Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Javed A Mohammed
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
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Mohsenzadeh A, Movahedi M, Saatchi M, Parvaneh N, Shariat M, Aghamohammadi A, Gharagozlou M. Serum sickness-like reactions in Iranian children: a registry-based study in a referral center. Allergol Immunopathol (Madr) 2020; 48:424-429. [PMID: 32653225 DOI: 10.1016/j.aller.2019.07.012] [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: 05/26/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Considering that no studies have been done on a comprehensive review of Serum sickness-like reactions patients (SSLRs) at a referral center in Iran so far, this study aimed to determine the clinical and laboratory characteristics of children with SSRL in Tehran Children's Medical Center. PATIENTS The present study was a registry-based study in which the data of 94 SSLRs patients registered in a two-year period were investigated. Confirmation of fever, rash, urticaria, arthralgia / arthritis and history of antibiotic consumption up to three weeks before were the criteria for the diagnosis. RESULTS Fifty-one (54 %) patients were male with mean age of 56 ± 30 months and there was no significant difference in the age of the two genders. The mean onset of symptoms before hospitalization were 3.8 ± 2.7 days (1-14 days); this mean was significantly higher in males than in females (4.6 ± 2.9 versus 2.9 ± 1.7 days, P-value = 0.003). Among antibiotics, Co-amoxiclav and Cefixime antibiotics had the most frequency by 31 % and 33 %, respectively as the most important incidence factor of SSLRs. The mean duration of consumption of culprit medications in the incidence of SSLRs was 5.6 ± 2.9 days with a range of 1-15 days. CONCLUSIONS This study showed that among the antibiotics, Co-amoxiclav and Cefixime are more prevalent and a review of prescribing these two antibiotics for the treatment of the children's infections is essential if this finding is confirmed by other Iranian scholars.
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Abstract
Drug eruptions in children are common but in general less studied than their adult counterparts. Aside from having significant impact on the child's health and quality of life, these reactions can limit what medications the patient can receive in the future. Familiarity with pediatric drug eruptions is important for accurate diagnosis and to prevent future recurrence or ineffective therapy. Our current understanding of how drug reactions differ mechanistically between children and adults is poor. There are multiple factors that could be contributing to the differing incidence, presentation, and treatment modalities offered to pediatric versus adult patients. For many of these cutaneous drug reactions, the treatment regime is not standardized, being based primarily on case reports. Although not comprehensive, this review highlights common pediatric drug eruption patterns and discuss diagnostic mimickers. Five cutaneous adverse drug reactions in the pediatric population are presented: morbilliform (exanthematous) eruptions, urticarial eruptions, serum sickness-like reactions, fixed drug eruptions, and DRESS syndrome. Clinical features, diagnostic workup, and management are discussed with an emphasis on the pediatric population.
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Affiliation(s)
- EmilyD Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Colleen K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Gelincik A, Cavkaytar O, Kuyucu S. An Update on the Management of Severe Cutaneous Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3881-3901. [DOI: 10.2174/1381612825666191106115556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/01/2019] [Indexed: 12/15/2022]
Abstract
Severe cutaneous drug hypersensitivity reactions involve of different mechanisms , some of which are
life-threatening, such as Stevens-Johnson syndrome/toxic epidermal necrolysis, drug reaction with eosinophilia
and systemic symptoms, acute generalized exanthematous pustulosis, generalized bullous fixed drug eruptions,
serum sickness and serum sickness-like reaction and drug-induced vasculitis. These reactions may have substantial
morbidity and mortality. In the past years, successive studies have provided new evidence regarding the
pathogenesis of some of these severe reactions and revealed that underlying mechanisms are highly variable.
Since these reactions have unique presentations and distinct pathomechanisms, the treatment methods and response
rates might be different among various entities. Although supportive and local therapies are sufficient in
some of these reactions, targeted immunosuppressive treatments and even mechanistic therapies such as plasmapheresis
may be required in severe ones. However, there is still insufficient evidence to support the best treatment
options for these patients since number of patients and large-scale studies are limited. In this review, conventional
and new treatment options for severe cutaneous drug hypersensitivity reactions are presented in detail in
order to provide the contemporary approaches to lessen the morbidity and mortality relevant to these severe iatrogenic
diseases.
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Affiliation(s)
- Aslı Gelincik
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Semanur Kuyucu
- Department of Pediatric Allergy and Immunology, Mersin University, Faculty of Medicine, Mersin, Turkey
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Ogawa E, Shoji K, Miyairi I. Fever as a predictor of positive lymphocyte transformation test. Pediatr Int 2019; 61:951-955. [PMID: 31267605 DOI: 10.1111/ped.13937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/13/2019] [Accepted: 05/24/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few studies have characterized the clinical manifestations of delayed antibiotic hypersensitivity (AH) diagnosed using objective methods. The lymphocyte transformation test (LTT) is a reproducible method to diagnose type IV hypersensitivity. The purpose of the study was to evaluate the characteristics of delayed AH diagnosed on LTT in children. METHODS We performed a retrospective analysis of patients who were evaluated for AH using LTT at National Center for Child Health and Development, Tokyo, from 2002 to 2014. We extracted patient demographics, type and duration of antibiotics, and clinical characteristics from the medical records. Clinical manifestations were compared between LTT-positive and LTT-negative cases. RESULTS Seventy-five cases for which 101 drugs were tested were included in this study. LTT was positive against 34 drugs in 26 cases. Median age was 5 years (IQR, 1-9 years), and 49% of patients had underlying disease. LTT was performed at a median of 18 days (IQR, 4-59 days) after the suspected episode. The median number of days from the initiation of therapy to the onset of symptoms was 4. Rash was the most common manifestation (89%). Fever (>38°C) was observed in 20 cases (27%). Onset of fever preceded the rash in nine cases (45%), appeared simultaneously in five (25%), appeared afterwards in four (20%), and was unknown in two (10%). Fever was an independent factor associated with AH when comparing LTT-positive and LTT-negative cases (OR, 3.61; 95%CI: 1.03-12.64). CONCLUSIONS Fever was a common presenting symptom of delayed AH in children aged ≤18 years.
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Affiliation(s)
- Eiki Ogawa
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan.,Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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9
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Abstract
PURPOSE OF REVIEW Pediatric drug hypersensitivity is a rapidly evolving field. The purpose of this paper is to review the current state of pediatric drug hypersensitivity and highlight new developments in diagnosis and management. RECENT FINDINGS This paper will discuss the safety and use of risk stratification to proceed directly to oral challenge without prior skin testing for β-lactam reactions. We review unique aspects of pediatric drug challenges and desensitizations. It is important to accurately diagnose pediatric drug hypersensitivity reactions through a detailed history, physical examination, and available diagnostic testing. Understanding of the underlying mechanism leads to appropriate classification which is necessary to direct management. The decision to perform drug challenge, desensitization, or recommend avoidance of a medication can have a significant impact on a patient's treatment. Utilization of weight-based dose and infusion rate adjustments for current drug challenge and desensitization protocols optimize success.
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Barni S, Mori F, Fili L, Parronchi P, Novembre E. Amoxicillin/clavulanic acid-induced exfoliative dermatitis in a child. Minerva Pediatr 2018; 70:495-496. [PMID: 30302990 DOI: 10.23736/s0026-4946.17.04845-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Simona Barni
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy -
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Lucia Fili
- Unit of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paola Parronchi
- Unit of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
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11
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Sharma PK, Misra AK, Gupta N, Khera D, Gupta A, Khera P. Pediatric pharmacovigilance in an institute of national importance: Journey has just begun. Indian J Pharmacol 2018. [PMID: 29515280 PMCID: PMC5830850 DOI: 10.4103/ijp.ijp_256_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE: The objective of this study is to determine the nature and severity of adverse drug reactions (ADRs) in pediatric patients. MATERIALS AND METHODS: In this retrospective cohort study, we extracted the data from all the available pediatric ADR forms submitted to ADR monitoring center (AMC) from May 2014 to December 2016. The data including nature, frequency, causality (World Health Organization [WHO] causality scale), and the severity (Hartwig and Siegel scale for severity) of ADR were extracted. We also assessed the preventability of the event on modified Schumock and Thornton scale of ADR preventability. RESULTS: There were a total of 20 pediatric ADRs reported during this period. Nearly two-thirds of the ADRs occurred in patients who were receiving multiple drugs (polytherapy). Antimicrobial agents were the most commonly implicated drugs. The most common ADRs were skin rash (maculopapular, erythematous, and urticaria, itching, etc.). The severity and preventability scales indicated that most reactions (18/20) were moderate in nature and all were preventable. Four reactions were “certainly” and ten ADRs were “probably” related to the suspected drug as determined by the WHO causality assessment. CONCLUSION: Frequency of ADR increased with number of medications patient was receiving. Health-care providers (HCPs) involved in the care of children must be aware of this fact and should use additional drugs when absolutely necessary. They should be involved in pharmacovigilance program by exchanging and updating each other through sharing constructive information, communication, and education concerning the appropriate use of drugs in children. Pediatric pharmacovigilance is the need of the hour and should be given utmost importance for monitoring the safety of drugs in children. Motivating HCPs for voluntary reporting of ADRs for preventing the morbidity and mortality in this vulnerable population could be of immense importance.
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Affiliation(s)
- Pramod Kumar Sharma
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arup Kumar Misra
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neeraj Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ajay Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Khera
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Norton AE, Konvinse K, Phillips EJ, Broyles AD. Antibiotic Allergy in Pediatrics. Pediatrics 2018; 141:peds.2017-2497. [PMID: 29700201 PMCID: PMC5914499 DOI: 10.1542/peds.2017-2497] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/11/2022] Open
Abstract
The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.
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Affiliation(s)
- Allison Eaddy Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, and
| | - Katherine Konvinse
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J. Phillips
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, and,John A. Oates Institute for Experimental Therapeutics and Department of Pharmacology, School of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee;,Division of Infectious Disease, Departments of Medicine and,Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee;,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia; and
| | - Ana Dioun Broyles
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Suspicious drug hypersensitivity reactions in pediatric patients: a retrospective single-center study. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yorulmaz A, Akın F, Sert A, Ağır MA, Yılmaz R, Arslan Ş. Demographic and clinical characteristics of patients with serum sickness-like reaction. Clin Rheumatol 2017; 37:1389-1394. [DOI: 10.1007/s10067-017-3777-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 12/26/2022]
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15
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Ogese MO, Ahmed S, Alferivic A, Betts CJ, Dickinson A, Faulkner L, French N, Gibson A, Hirschfield GM, Kammüller M, Meng X, Martin SF, Musette P, Norris A, Pirmohamed M, Park BK, Purcell AW, Spraggs CF, Whritenour J, Naisbitt DJ. New Approaches to Investigate Drug-Induced Hypersensitivity. Chem Res Toxicol 2016; 30:239-259. [DOI: 10.1021/acs.chemrestox.6b00333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Monday O. Ogese
- Pathology Sciences, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Shaheda Ahmed
- Alcyomics
Ltd c/o Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, U.K
| | - Ana Alferivic
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Catherine J. Betts
- Pathology Sciences, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Road, Cambridge CB4 0WG, U.K
| | - Anne Dickinson
- Alcyomics
Ltd c/o Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, U.K
| | - Lee Faulkner
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Neil French
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Andrew Gibson
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Gideon M. Hirschfield
- Centre for Liver Research, NIHR Birmingham Liver Biomedical
Research Unit, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham B15 2TT, U.K
| | - Michael Kammüller
- Novartis Institutes for Biomedical Research, Klybeckstrasse 141, CH-4057 Basel, Switzerland
| | - Xiaoli Meng
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Stefan F. Martin
- Department of Dermatology and Venereology,
Allergy Research Group, University of Freiburg, Hauptstraße 7, 79104 Freiburg, Germany
| | - Philippe Musette
- Department of Dermatology and INSERM, University of Rouen, 905 Rouen, France
| | - Alan Norris
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
- The Wolfson Centre
for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - B. Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
| | - Anthony W. Purcell
- Infection and Immunity
Program and Department of Biochemistry and Molecular Biology, Biomedicine
Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Colin F. Spraggs
- Medicines
Research Centre, GlaxoSmithKline, Gunnels Wood Road, Stevenage SG1 2NY, U.K
| | - Jessica Whritenour
- Drug Safety Research and Development, Pfizer, Eastern Point Road, Groton, Connecticut 06340, United States
| | - Dean J. Naisbitt
- MRC Centre for Drug Safety Science, Department of Molecular
and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, U.K
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Les effets indésirables médicamenteux en pédiatrie : expérience d’un centre régional de pharmacovigilance. Therapie 2016; 71:467-473. [DOI: 10.1016/j.therap.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic reactions with mucocutaneous involvement that carry elevated mortality rates. They differ along a spectrum of severity based upon body surface area affected. These conditions, usually caused by a drug or infection, are believed to result from cell-mediated and often drug-specific cytotoxic reactions against keratinocytes, leading to widespread dermal-epidermal detachment. Studies attempting to identify potential curative therapies such as intravenous immune globulin (IVIG) and corticosteroids remain inconclusive. However, improved outcomes have been demonstrated by early withdrawal of offending medications, early transfer to an intensive care unit or burn unit, and aggressive supportive care. Due to the rare incidence of SJS and TEN, its recurrence among survivors hints at future vulnerability for these patients, and notorious offending medications should thus be avoided. This clinical review will highlight the diagnostic and therapeutic challenges posed by SJS and TEN, while emphasizing the need to maintain them high on the emergency medicine physician's differential. The review will also detail the supportive measures to take for preventing the rapid progression of mucocutaneous complications and subsequent sepsis-related mortality.
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Petrosino MI, Attanasi M, Marcovecchio ML, Scaparrotta A, Di Pillo S, Rossi N, Chiarelli F. Erythema multiforme syndrome associated with acute acquired cytomegalovirus infection. Arch Med Sci 2016; 12:684-6. [PMID: 27279865 PMCID: PMC4889704 DOI: 10.5114/aoms.2016.59943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Marina Attanasi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | | | | | - Nadia Rossi
- Department of Pediatrics, University of Chieti, Chieti, Italy
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Abstract
The skin has a relatively limited range of responses to injury regardless of the specific mechanism underlying the insult. When the skin's barrier function is disrupted, it mounts an inflammatory and proliferative response in an effort to restore this essential function. The epidermal keratinocyte is central to the initiation of the skin's response, triggering an immunologic cascade that leads to the stereotypic morphologic responses that we encounter as pathologists. Drug-induced immune-mediated cutaneous injuries or "drug eruptions" are relatively common, sometimes with overlapping mechanisms, and it is often possible to classify these based on the classical hypersensitivity-type reactions. A specific type of immune-mediated skin injury is psoriasis. The pathogenesis of psoriasis is multifactorial but involves the interaction of environmental factors with a genetic predisposition. The initial stimulus triggering the development of psoriatic lesions involves activation of epidermal keratinocytes, with subsequent amplification driven by cross talk between the adaptive and innate immune systems. Several cytokines produced by Th17 T helper cells have recently been shown to be important in the pathogenesis of psoriasis, namely, interleukin-23 (IL-23) and IL-17, due to demonstrated clinical efficacy of cytokine blockade; and IL-22, based on its effects in both in vitro and in vivo models.
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Affiliation(s)
- Dimitry M Danilenko
- Department of Safety Assessment, Genentech, Inc., South San Francisco, California, USA
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Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, Ott H, Atanaskovic-Markovic M, Kidon M, Caubet JC, Terreehorst I. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy 2016; 71:149-61. [PMID: 26416157 DOI: 10.1111/all.12774] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/22/2022]
Abstract
When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sickness-like reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.
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Affiliation(s)
- E. R. Gomes
- Allergology Department; Centro Hospitalar do Porto; Porto Portugal
| | - K. Brockow
- Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Department of Dermatology und AllergologyBiederstein; Technical University Munich; Munich Germany
| | - S. Kuyucu
- Department of Pediatric Allergy and Clinical Immunology; Faculty of Medicine; Mersin University; Mersin Turkey
| | - F. Saretta
- Pediatric Department; Hospital of Palmanova; A.S.S.5 ‘Bassa Friulana’; Palmanova UD Italy
| | - F. Mori
- Allergy Unit; Department of Pediatric; Anna Meyer Children's Hospital; University of Florence; Florence Italy
| | - N. Blanca-Lopez
- Allergy Department; Infanta Leonor University Hospital; Madrid Spain
| | - H. Ott
- Division of Pediatric Dermatology; Children's Hospital Auf der Bult; Hannover Germany
| | - M. Atanaskovic-Markovic
- University Children's Hospital of Belgrade; Medical Faculty University of Belgrade; Belgrade Serbia
| | - M. Kidon
- Allergy and Clinical Immunology Unit and Institute for Pediatric Pulmonology and National CF Center; Safra Children's Hospital; Tel Hashomer Israel
| | - J.-C. Caubet
- Division of Pediatric Allergy; University Hospital of Geneva; Geneva Switzerland
| | - I. Terreehorst
- Department of ENT and Pediatrics; AMC; Amsterdam The Netherlands
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Mahmoud KH, Alzolibani AA, Rasheed Z, Farouk Y, Saif GB, Al Robaee AA. Interleukin-4 and interferon-γ are possible allergic markers in pediatric patients with β-lactam hypersensitivity. Int J Appl Basic Med Res 2016; 6:276-281. [PMID: 27857897 PMCID: PMC5108106 DOI: 10.4103/2229-516x.192595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: β-lactam agents are known to elicit T-cell-mediated immune responses that play a central role in the onset of allergic reactions, but the involvement of specific type of cytokines in drug allergy remains largely unexplored in humans. Objectives: This study was undertaken to investigate the role of cytokines involvement in pediatric patients with β-lactam hypersensitivity and to determine whether involvement of cytokines in drug-mediated reactions are important for the perspective of allergic patient's management. Methods: β-lactam-induced hypersensitivity reactions in eighty pediatric patients were determined by clinical manifestations and skin prick or intradermal testing. Production of T-helper (Th) type-1 cytokine interferon (INF)-γ, Th-2 cytokine interleukin (IL)-4, regulatory T-cell cytokine IL-10, and other cytokines IL-6 and IL-12 were determined by sandwich ELISAs. Results: Diagnosis of β-lactam allergy was confirmed in 53 pediatric patients. IL-4 secretion in patients' sera was significantly higher as compared with healthy controls (P < 0.05). However, INF-γ level in patients' sera was significantly lower as compared with controls (P < 0.05). No significant alterations were found in the protein secretion of IL-10, IL-12, and IL-6 in allergic patients as compared with controls (P > 0.05). Conclusion: We conclude that IL-4 is specific marker for the diagnosis of β-lactam-induced hypersensitivity. Moreover, IL-4 in combination with INF-γ is more sensitive for the diagnosis of these reactions. This study also concludes that both IL-4 and INF-γ may play an active role in the onset of allergic reactions against β-lactam antibiotics.
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Affiliation(s)
- Khaled H Mahmoud
- Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | | | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Yasser Farouk
- Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ghada Bin Saif
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad A Al Robaee
- Department of Dermatology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Affiliation(s)
| | - Allison Hsu
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Luis Seguias
- University of Texas Southwestern Medical Center, Dallas, TX
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Cutaneous drug reactions in children: a multicentric study. Postepy Dermatol Alergol 2014; 31:368-71. [PMID: 25610351 PMCID: PMC4293388 DOI: 10.5114/pdia.2014.43881] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 05/21/2014] [Accepted: 06/06/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction According to studies conducted in outpatients, it is estimated that 2.5% of children who are treated with a drug will experience a cutaneous adverse drug reaction (CADR). Aim To analyze the CADR reports involving pediatric patients recorded by three different university hospitals for describing common, serious, and interesting cutaneous drug eruption patterns. Material and methods For this purpose, the patients’ data from three different universities were reviewed retrospectively. Diagnosis was based on history, clinical findings and laboratory test results. The CADRs were classified into seven categories; urticaria, angioedema, maculopapular eruption, fixed drug eruption, erythema multiforme, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms syndrome. Results A total of 122 patients who had CADRs were enrolled in the study. The most frequently detected cutaneous drug reactions were urticaria + angioedema. Most of patients had no previous experience with the same drug and the most common causative agent of CADRs was antimicrobials. Conclusions Since CADRs are relatively rare, the current multicentric study can provide meaningful information about the cutaneous eruption patterns of commonly used drugs.
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Abstract
Roseola infantum, also known as exanthem subitum or sixth disease, is a generally benign febrile exanthem of infancy. It has a characteristic clinical course of high fever followed by the appearance of an exanthem upon defervescence. Febrile seizures are a frequent complication. Roseola is caused by infection with human herpesviruses 6 or 7 (HHV-6/7), which are acquired at a young age. Diagnosis is made by serology or by virus detection in body fluids and tissues. Treatment of roseola is supportive; recovery is usually complete with no significant sequelae. However, HHV-6/7 can reactivate in immunocompetent as well as immunocompromised individuals with severe systemic consequence.
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Tripathy A, Kumari K M, Babu A V M, Pai SB, Kumar D M. Anything Rare is Possible: Letrozole Induced Eczematous Skin Eruption. J Clin Diagn Res 2014; 8:YD03-4. [PMID: 25121052 DOI: 10.7860/jcdr/2014/9028.4498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 04/22/2014] [Indexed: 11/24/2022]
Abstract
Letrozole is used as first line drug in postmenopausal women with early-stage or advanced hormone-sensitive breast cancer. Letrozole has favourable tolerability profile when administered once daily and significant adverse reactions occur rarely. The objective of this report is to describe a case of eczematous skin eruption that occurred during letrozole treatment. A 61-year-old female patient was admitted with lump in the left breast. FNAC, HPE were done and the patient was diagnosed to have invasive ductal breast carcinoma. After a month of completing CT and EBRT, the patient was given 2.5 mg OD tab. letrozole at night. She developed itchy skin lesions over the right thigh that later generalised, at 6- weeks of treatment. The lesion has been defined as eczematous moderate to severe drug eruption. These lesions were attributed to letrozole therapy and recurred within 24h after rechallenge. Drug eruption is associated with many drugs but this is the first such report with letrozole. We suggest of being aware of such reactions during letrozole usage.
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Affiliation(s)
- Amruta Tripathy
- Postgraduate, Department of Pharmacology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - Meena Kumari K
- Associate Professor, Department of Pharmacology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - Mohan Babu A V
- Associate Professor, Department of Pharmacology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - Sathish B Pai
- Professor, Department of Dermatology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - Mahesh Kumar D
- Postgraduate, Department of Pharmacology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
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Noguera-Morel L, Hernández-Martín Á, Torrelo A. Cutaneous drug reactions in the pediatric population. Pediatr Clin North Am 2014; 61:403-26. [PMID: 24636653 DOI: 10.1016/j.pcl.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cutaneous adverse drug reactions (ADRs) constitute a major pediatric health problem frequently encountered in clinical practice, and represent a diagnostic challenge. Children are more susceptible than adults to errors in drug dosage because of their smaller body size; moreover, ADRs can mimic other skin diseases of children, especially viral exanthems. Most ADRs with cutaneous involvement are mild and resolve on withdrawal of the causative drug. The most common forms of cutaneous ADRs, maculopapular exanthems and urticarial reactions, have excellent outcomes. Less frequent but more severe reactions may incur a risk of mortality.
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Affiliation(s)
- Lucero Noguera-Morel
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain
| | - Ángela Hernández-Martín
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain
| | - Antonio Torrelo
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain.
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S P, K M, S A. Causality, severity and preventability assessment of adverse cutaneous drug reaction: a prospective observational study in a tertiary care hospital. J Clin Diagn Res 2013; 7:2765-7. [PMID: 24551632 DOI: 10.7860/jcdr/2013/7430.3753] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/04/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The number of subjects involved in a clinical trial are limited, whose findings cannot be extrapolated to the entire population.Due to the emergence of newer molecules the pattern of Adverse Cutaneous Drug Reaction(ACDR) also changes frequently. The need for this study is for early diagnosis, to reduce the morbidity and mortality due to ACDR and to ensure safety of the patients. MATERIAL AND METHODS Forty one subjects with the diagnosis of ACDR were included in the study for a period of 12 months(Jan 2009- Dec 2009). The informations such as patient demographic details, drug history, associated comorbid conditions and pattern of the skin reaction were noted. Assessment was done for causality, severity and preventability using separate valid scales. RESULTS The most common ACDR was fixed drug eruption (43.9%) and the most common causative drug for the same was surprisingly found to be paracetamol. Antimicrobials were the most common causative drug group and two significant associated risk factors were multiple drug intake and history of allergy. Among the total reactions 78% were of probable category and 59% were of moderate level severity reaction. Out of which 12% of the cases were definitely preventable.
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Affiliation(s)
- Padmavathi S
- Assistant Professor, Department of Pharmacology, Mahatma Gandhi Medical College and Research institute , Puducherry, India
| | - Manimekalai K
- Professor, Department of Pharmacology, Mahatma Gandhi Medical College and Research institute , Puducherry, India
| | - Ambujam S
- Professor, Department of Dermatology, Venereology and Leprology, Indira Gandhi Medical college and Research institute , Puducherry, India
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Abstract
Cutaneous drug reactions account for a large proportion of adverse drug reactions. Cutaneous drug reactions can be very challenging to diagnose. They can mimic many other skin diseases; this is especially evident during childhood, when viral exanthems are commonplace. Also, if a patient is taking numerous medications, establishing causality to a specific drug can be multifaceted and difficult. The purpose of this review is to highlight an approach to the diagnosis of a suspected cutaneous drug reaction in a child. We have classified different types of drug eruptions by morphology: exanthematous, urticarial, pustular, and bullous. Within each of these groups we have divided them into simple, benign, or non-febrile and complex or febrile reactions. We also include a miscellaneous group to ensure a methodical review.
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Maokola W, Chemba M, Hamisi Y, Mrisho M, Shirima K, Manzi F, Masanja M, Willey B, Alonso P, Mshinda H, Tanner M, Schellenberg JRMA, Schellenberg D. Safety of sulfadoxine/pyrimethamine for intermittent preventive treatment of malaria in infants: evidence from large-scale operational research in southern Tanzania. Int Health 2013; 3:154-9. [PMID: 24038364 DOI: 10.1016/j.inhe.2011.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Intermittent preventive treatment with sulfadoxine/pyrimethamine (SP) is recommended for malaria prevention in infants (IPTi-SP). Serious adverse events, including Stevens-Johnson syndrome (SJS), have been reported following exposure to SP, but few infant-specific data exist. The safety of IPTi-SP was evaluated as part of a pilot implementation programme in southern Tanzania using three methods: spontaneous adverse event reporting to capture suspected adverse drug reactions (ADR); a census survey documenting rash-related hospital admissions among children < 2 years of age; and verbal autopsies (VA) completed for rash-related deaths in 2-11-month-olds. Approximately 82 000 IPTi-SP doses were administered to approximately 29 000 children. In total, 119 suspected ADRs were reported, 13 in children aged <2 years, only one of whom had received IPTi-SP. The census involved 243 612 households. Only one rash-related admission was reported amongst 1292 children aged 2-11 months, but this child had no history of exposure to SP. Moreover, 30 of 699 deaths in 2-11-month-olds were said to have been associated with a skin rash. The rates of rash-associated death were 0.59/1000 person-years at risk (PYAR) and 1.17/1000 PYAR in intervention and comparison areas, respectively (P = 0.79). VAs did not suggest SJS or any other ADR. We conclude that IPTi-SP is associated with a very low incidence of severe skin reactions. [ClinicalTrials.gov identifier: NCT00152204].
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Raucci U, Rossi R, Da Cas R, Rafaniello C, Mores N, Bersani G, Reale A, Pirozzi N, Menniti-Ippolito F, Traversa G, in Drug and Children IMSGFVS. Stevens-johnson syndrome associated with drugs and vaccines in children: a case-control study. PLoS One 2013; 8:e68231. [PMID: 23874553 PMCID: PMC3712963 DOI: 10.1371/journal.pone.0068231] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Stevens-Johnson Syndrome (SJS) is one of the most severe muco-cutaneous diseases and its occurrence is often attributed to drug use. The aim of the present study is to quantify the risk of SJS in association with drug and vaccine use in children. METHODS A multicenter surveillance of children hospitalized through the emergency departments for acute conditions of interest is currently ongoing in Italy. Cases with a diagnosis of SJS were retrieved from all admissions. Parents were interviewed on child's use of drugs and vaccines preceding the onset of symptoms that led to the hospitalization. We compared the use of drugs and vaccines in cases with the corresponding use in a control group of children hospitalized for acute neurological conditions. RESULTS Twenty-nine children with a diagnosis of SJS and 1,362 with neurological disorders were hospitalized between 1(st) November 1999 and 31(st) October 2012. Cases were more frequently exposed to drugs (79% vs 58% in the control group; adjusted OR 2.4; 95% CI 1.0-6.1). Anticonvulsants presented the highest adjusted OR: 26.8 (95% CI 8.4-86.0). Significantly elevated risks were also estimated for antibiotics use (adjusted OR 3.3; 95% CI 1.5-7.2), corticosteroids (adjusted OR 4.2; 95% CI 1.8-9.9) and paracetamol (adjusted OR 3.2; 95% CI 1.5-6.9). No increased risk was estimated for vaccines (adjusted OR: 0.9; 95% CI 0.3-2.8). DISCUSSION Our study provides additional evidence on the etiologic role of drugs and vaccines in the occurrence of SJS in children.
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Affiliation(s)
- Umberto Raucci
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Rossella Rossi
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Concita Rafaniello
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, Second University of Napoli, Napoli, Italy
| | - Nadia Mores
- Pharmacology and Paediatrics, Università Cattolica S. Cuore, Roma, Italy
| | - Giulia Bersani
- Pharmacology and Paediatrics, Università Cattolica S. Cuore, Roma, Italy
| | - Antonino Reale
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Nicola Pirozzi
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Francesca Menniti-Ippolito
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Giuseppe Traversa
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
- * E-mail:
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HLA-A 31:01 and HLA-B 15:02 as genetic markers for carbamazepine hypersensitivity in children. Clin Pharmacol Ther 2013; 94:142-9. [PMID: 23588310 PMCID: PMC3839910 DOI: 10.1038/clpt.2013.55] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The occurrence of hypersensitivity reactions including rare but life-threatening Stevens-Johnson syndrome (SJS) and drug-induced hypersensitivity syndrome (HSS) limits the use of the anticonvulsant carbamazepine (CBZ). HLA-B*15:02 and HLA-A*31:01 have been identified as predictive genetic markers for CBZ hypersensitivity in Asian and European patients. To replicate these genetic associations in pediatric patients from North America with a diverse ethnic background, we investigated HLA-A*31:01 and HLA-B*15:02 in 42 children with CBZ hypersensitivity, and 91 CBZ-tolerant children from across Canada. HLA-A*31:01 was significantly associated with CBZ-HSS (odds ratio (OR): 26.4, p=0.0025) and maculopapular exanthems (OR: 8.6, p=0.0037), but not with CBZ-SJS. Conversely, HLA-B*15:02 was associated with CBZ-SJS (OR: 38.6, p=0.002), but not HSS and maculopapular exanthems. This study is the first to demonstrate the association of HLA-A*31:01 with CBZ hypersensitivity in children, providing important replication of this association and highlighting the importance of HLA-A*31:01 as a predictive biomarker across various ancestries.
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Aagaard L, Hansen E. Cutaneous adverse drug reactions reported in children: a national register-based study. Br J Dermatol 2013; 168:434-7. [DOI: 10.1111/j.1365-2133.2012.11133.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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de Sousa A, Rabarijaona LP, Tenkorang O, Inkoom E, Ravelomanantena HV, Njarasoa S, Whang JN, Ndiaye JL, Ndiaye Y, Ndiaye M, Sow D, Akadiri G, Hassan J, Dicko A, Sagara I, Kubalalika P, Mathanga D, Bizuneh K, Randriasamimanana JR, Recht J, Bjelic I, Dodoo A. Pharmacovigilance of malaria intermittent preventive treatment in infants coupled with routine immunizations in 6 African countries. J Infect Dis 2012; 205 Suppl 1:S82-90. [PMID: 22315391 DOI: 10.1093/infdis/jir799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment in infants (IPTi) is a new malaria control strategy coupled with the delivery of routine immunizations recommended by the World Health Organization since 2009 for countries with moderate to high endemicity. To evaluate its safety profile and identify potential new adverse events (AEs) following simultaneous administration of sulfadoxine-pyrimethamine (SP-IPTi) with immunizations, we measured AE incidence and evaluated spontaneous AE reporting. METHODS A cohort event monitoring study was conducted on 24 000 infants in 2 countries after administration of SP-IPTi during routine immunizations. Additional pharmacovigilance training and supervision were conducted to stimulate AE passive reporting in 6 African countries. RESULTS No serious AEs were found by active follow-up, representing 95% probability that the rate does not exceed 1 per 8000. No serious AEs were found by retrospective review of hospital registers. The rate of moderate AEs probably linked to immunization and/or SP-IPTi was 1.8 per 1000 doses (95% confidence interval, 1.50-2.00). Spontaneous reporting of AEs remained <1% of cases collected by active follow-up. CONCLUSIONS Simultaneous administration of SP-IPTi and immunizations is a safe strategy for implementation with a low risk of serious AEs to infants. Strategies toward strengthening spontaneous reporting in Africa should include not only the provider but also beneficiaries or their caregivers.
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Ott H. [Cutaneous adverse drug reactions in childhood and adolescence]. Hautarzt 2012; 63:97-103. [PMID: 22290276 DOI: 10.1007/s00105-011-2197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Adverse drug reactions (ADR) occur in nearly 10% of hospitalized children and in about 1.5% of ambulatory pediatric patients. The skin is the most frequently affected target organ in drug hypersensitivity (DH) reactions, which account for 20% of all ADR. Due to its pathophysiological heterogeneity and the ensuing morphological diversity, DH often represents a clinical and therapeutic challenge. Urticarial and maculopapular eruptions are usually restricted to the skin and rarely require systemic treatment or hospital admission once the culprit drug has been withdrawn. However, extracutaneous affections should be ruled out promptly in individuals with polymorphous rashes accompanied by fever and lymphadenopathy as well as in patients with bullous skin lesions. Children affected by severe drug reactions usually require in-hospital surveillance and interdisciplinary supportive therapy.
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Affiliation(s)
- H Ott
- Abteilung Pädiatrische Dermatologie und Allergologie, Katholisches Kinderkrankenhaus Wilhelmstift, Liliencronstr. 130, 22149
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Priyadharsini R, Surendiran A, Adithan C, Sreenivasan S, Sahoo FK. A study of adverse drug reactions in pediatric patients. J Pharmacol Pharmacother 2011; 2:277-80. [PMID: 22025857 PMCID: PMC3198524 DOI: 10.4103/0976-500x.85957] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To study the adverse drug reaction (ADR) pattern in a pediatric population in a tertiary care hospital. Materials and Methods: An observational study was done in the department of pediatrics in a tertiary care hospital. The ADRs occurring in the inpatient wards and outpatient department of pediatrics were actively monitored. The collected reports were analyzed for ADR pattern, drug groups, demographic profile, causality, severity, and preventability of the ADR. Results: A total of 30 ADRs were documented during the mid period of 2009 among pediatric patients. Most of the ADRs (60%) occurred below the age of 1 year. Antibiotics comprised the major group of drugs causing ADRs (67%). Rashes and urticaria were the most common type of ADR (37%) followed by fever, anaphylactic shock, vomiting, chills, and rigors. A single case of death had been reported in the study period. There were more occurrences of ADRs with multiple drugs compared to single drug therapy. About 80% of the ADRs were of probable causality and 87% were of probable preventability. There were no mild reactions, with 77% of reactions being moderate and 23% of reactions being severe in the severity scale. Conclusions: ADRs occur more among infants and antibiotics were more commonly implicated. Most of the reactions were of moderate severity. This indicates the need for a rigid ADR monitoring among pediatric patients to ensure safety of drug therapy.
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Affiliation(s)
- R Priyadharsini
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ott H. Kutane Arzneimittelreaktionen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Na HR, Lee JM, Jung JW, Lee SY. Usefulness of drug provocation tests in children with a history of adverse drug reaction. KOREAN JOURNAL OF PEDIATRICS 2011; 54:304-9. [PMID: 22025924 PMCID: PMC3195796 DOI: 10.3345/kjp.2011.54.7.304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/03/2011] [Accepted: 05/10/2011] [Indexed: 12/04/2022]
Abstract
Purpose There are very few reports of adverse drug reactions (ADR) and almost no study of drug provocation test (DPT) in Korean children. We aimed to assess the role of DPT in children with unpredictable ADRs, and compare the causative drugs and clinical characteristics between detailed history of ADRs and result of DPTs. Methods We included 16 children who were experienced ADRs referred to pediatric allergy clinic at Ajou University Hospital (January 2006 to December 2009). With various suspected drugs, 71 DPTs were done in 16 patients using our own protocol, and skin tests to antibiotics were combined in ADRs to antibiotics in medical history. Results There were 17 (23.9%) positive DPTs results out of 71 individual DPTs, and 11 patients (68.8%) from 16 patients were positive to at least one drug. Drugs causing positive reactions were acetaminophen in 5 (31%), Non-steroidal anti-inflammatory drugs in 4 (25%), penicillin in 3 (19%), cephalosporin in 2 (13%), and cotrimoxazole, macrolide and lactose in 1 each. Conclusion DPT seems a safe and useful procedure to confirm causative drug and identify safely administering alternative drugs in children with ADR.
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Affiliation(s)
- Hye Ran Na
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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O’Keeffe DT, Cooke R. Serum sickness like reaction in an 11-year-old boy. Ir J Med Sci 2011; 180:605-6. [DOI: 10.1007/s11845-009-0415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mallet S. Réaction cutanée chez un enfant qui prend un médicament. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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43
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Affiliation(s)
- Sarah Powers
- Department of Pediatrics, University of New Mexico School of Medicine, Santa Fe, NM, USA
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Affiliation(s)
- Brandon D Newell
- University of Missouri-Kansas City, Children's Mercy Hospitals and Clinics, MO 64108, USA.
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45
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Buonomo A, Altomonte G, De Pasquale T, Lombardo C, Pecora V, Sabato V, Colagiovanni A, Rizzi A, Aruanno A, Pascolini L, Patriarca G, Nucera E, Schiavino D. Allergic and Non-Allergic Drug Hypersensitivity Reactions in Children. Int J Immunopathol Pharmacol 2010; 23:881-90. [DOI: 10.1177/039463201002300324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adverse drug reactions (ADR) are an important medical problem. The aim of this study is to investigate the clinical characteristics of children with ADR and to assess the tolerability of alternative drugs in children (under 16 yrs of age) with a history of ADR. We studied 278 children (132 males and 146 females). Patients were studied by recording personal history and performing in vivo skin testing, in vitro laboratory tests and challenge tests. Patients who had experienced mild adverse reactions underwent challenge tests without any premedication; patients with a clinical history of moderate reactions, received a premedication with sodium cromolyn 30 min before the oral challenge; patients with a clinical history of severe reactions or undergoing parenteral challenges, were given an antihistamine 30 minutes before. A total of 660 adverse events were reported with 126 different drugs involved. Antimicrobial agents were the most involved drugs (51.7%). Non-steroidal anti-inflammatory drugs were involved in 22.7% of episodes. The most reported symptoms were cutaneous. Allergy testing was negative in 272 patients. A diagnosis of drug allergy was reported for 6 patients. A total of 669 challenge tests were performed. 639 were negative at first attempt while 22 were positive. Eight were repeated using a different premedication and resulted negative. Hypersensitivity drug reactions in children are mainly non-allergic. A premedication with sodium cromolyn or with oral H1-antihistamines may be useful in preventing ADR.
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Affiliation(s)
- A. Buonomo
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - G. Altomonte
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - T. De Pasquale
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - C. Lombardo
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - V. Pecora
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - V. Sabato
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Colagiovanni
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Rizzi
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Aruanno
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - L. Pascolini
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - G. Patriarca
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - E. Nucera
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
| | - D. Schiavino
- Department of Allergology, Policlinico “A. Gemelli”, Catholic University of the Sacred Heart, Rome, Italy
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Saegeman V, Wynendaele W, Kerre S, Dedeurwaerdere F, Van den Driessche M, Moerman J. Transfusion-induced serum sickness. Transfusion 2009; 49:372-45. [DOI: 10.1111/j.1537-2995.2008.01956.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Ramírez-González MD, Herrera-Enríquez M, Villanueva-Rodríguez LG, Castell-Rodríguez AE. Role of epidermal dendritic cells in drug-induced cutaneous adverse reactions. Handb Exp Pharmacol 2009:137-162. [PMID: 19031025 DOI: 10.1007/978-3-540-71029-5_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Drug-induced adverse reactions (ADR) include any undesirable pharmacological effect that occurs following drug administration at therapeutic doses. The appearance of ADR significantly limits the use of drugs in as much as their clinical symptoms may range from very mild discomfort such as cutaneous rash, up to very severe, or even fatal tissue necrolysis such as the Stevens Johnson syndrome.One of the most frequently involved organ during ADR is the skin. Drug-induced cutaneous reactions (CDR) incidence is variable but they may appear in 2-3% of ambulatory patients, and it may increase to 10-15% when patients are hospitalized, or even be as high as 60% when co morbidity includes the presence of virus, bacteria, or parasites.Due to the fact that skin is one of the organs most frequently involved in ADR, in this work we analyze and propose a mechanism by which epidermal dendritic cells operating as the sentinels of the skin neuro-immune-endocrine system may contribute to CDR via either immunogenic or tolerogenic immune responses towards drugs, whenever they are administered topic or systemically.
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Affiliation(s)
- Maria Dolores Ramírez-González
- Department of Pharmacology and Tissue Cells Biology, School of Medicine, National Autonomous University of Mexico, Mexico.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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