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Yang SC, Chen CB, Lin MY, Zhang ZY, Jia XY, Huang M, Zou YF, Chung WH. Genetics of Severe Cutaneous Adverse Reactions. Front Med (Lausanne) 2021; 8:652091. [PMID: 34336873 PMCID: PMC8319741 DOI: 10.3389/fmed.2021.652091] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/11/2021] [Indexed: 12/19/2022] Open
Abstract
Severe cutaneous adverse reactions (SCARs) including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS) are T cells-mediated life-threatening immune reactions, most commonly induced by drug. The last decade has seen significant progress in SCARs research. Recent studies have unveiled the pathogenesis of SCARs involved in susceptible genes, including human leukocyte antigens (HLA) and drugs-T cell receptor (TCR) interaction that may trigger T cell activation with downstream immune signaling of cytokines/chemokines and specific cytotoxic proteins releases. Advances in identification of multiple genetic alleles associated with specific drugs related SCARS in different populations is an important breakthrough in recent years for prevention of SCARs. This article summarized the findings on genetic factors related to SJS/TEN, especially for HLA.
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Affiliation(s)
- Shang-Chen Yang
- Department of Dermatology, Xiamen Chang Gung Allergology Consortium, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chun-Bing Chen
- Department of Dermatology, Xiamen Chang Gung Allergology Consortium, Xiamen Chang Gung Hospital, Xiamen, China.,Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mao-Ying Lin
- Department of Dermatology, Xiamen Chang Gung Allergology Consortium, Xiamen Chang Gung Hospital, Xiamen, China
| | - Zhi-Yang Zhang
- Department of Dermatology, Xiamen Chang Gung Allergology Consortium, Xiamen Chang Gung Hospital, Xiamen, China
| | - Xiao-Yan Jia
- Department of Neurology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Ming Huang
- Department of Neurology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Ya-Fen Zou
- Department of Neurology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Wen-Hung Chung
- Department of Dermatology, Xiamen Chang Gung Allergology Consortium, Xiamen Chang Gung Hospital, Xiamen, China.,Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan.,Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
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Mendes D, Oliveira AR, Alves C, Batel Marques F. Spontaneous reports of hypersensitivity adverse drug reactions in Portugal: a retrospective analysis. Expert Opin Drug Saf 2020; 19:763-769. [PMID: 32167395 DOI: 10.1080/14740338.2020.1743262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hypersensitivity adverse drug reactions (ADRs) are usually serious, unpredictable, and associated with high morbidity and mortality. This study describes cases of hypersensitivity ADRs spontaneously reported in Central Portugal. METHODS Spontaneous reports (SRs) of ADRs received between 2010 and 2017 were reviewed to identify cases of hypersensitivity reactions, using a Standardized MedDRA Query (SMQ). Seriousness, expectedness, and causality were assessed. Descriptive statistics were used to analyze data. RESULTS Among 2050 SRs, 598 (29.2%) contained 726 hypersensitivity ADRs: 657 (90.5%) serious, 569 (78.4%) unexpected, and 469 (64.6%) certainly related to drug exposure. Anaphylactic reactions (n = 93; 12.8%), rash maculopapular (n = 82; 11.3%), rash (n = 67; 9.2%) and DRESS (n = 54; 7.4%) were the most common reactions. Frequently implicated drug classes comprised antibiotics (n = 150; 23.0%), antineoplastic agents (n = 124; 19.0%), antigout preparations (n = 54; 8.3%), and anti-inflammatories (n = 44; 6.8%). Top-causative drugs were allopurinol (n = 54; 8.3%), docetaxel (n = 46; 7.1%), and trimethoprim/sulfamethoxazole (n = 26; 4.0%). CONCLUSIONS Most hypersensitivity ADRs were serious, unexpected, and with strong causal relationship with suspected drugs. Allopurinol was the top-causative drug. Besides antibiotics and anti-inflammatories, antineoplastic agents were frequently cited. These results deserve further investigation.
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Affiliation(s)
- Diogo Mendes
- UFC-Coimbra Regional Pharmacovigilance Unit, CHAD-Centre for Health Technology Assessment and Drug Research, AIBILI-Association for Innovation and Biomedical Research on Light and Image , Coimbra, Portugal
| | - Ana Rita Oliveira
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra , Coimbra, Portugal
| | - Carlos Alves
- UFC-Coimbra Regional Pharmacovigilance Unit, CHAD-Centre for Health Technology Assessment and Drug Research, AIBILI-Association for Innovation and Biomedical Research on Light and Image , Coimbra, Portugal.,Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra , Coimbra, Portugal
| | - Francisco Batel Marques
- UFC-Coimbra Regional Pharmacovigilance Unit, CHAD-Centre for Health Technology Assessment and Drug Research, AIBILI-Association for Innovation and Biomedical Research on Light and Image , Coimbra, Portugal.,Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra , Coimbra, Portugal
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Yılmaz İ. Angiotensin-Converting Enzyme Inhibitors Induce Cough. Turk Thorac J 2019; 20:36-42. [PMID: 30664425 DOI: 10.5152/turkthoracj.2018.18014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/18/2018] [Indexed: 01/13/2023]
Abstract
Angiotensin-converting enzyme inhibitors (ACE-I) are widely used in diseases, such as hypertension, congestive heart failure, and myocardial infarction. Although these drugs are well tolerated, one out of five patients discontinues ACE-I due to drug side effects, mainly chronic cough. However, the pathogenesis of ACE-I-induced cough remains controversial and requires further study. In this review, the mechanisms that are suggested in ACE-I-induced cough pathophysiology will be discussed in detail in light of the current literature.
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Affiliation(s)
- İnsu Yılmaz
- Department of Chest Diseases, Division of Immunology and Allergy, Erciyes University School of Medicine, Kayseri, Turkey
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Papakonstantinou E, Müller S, Röhrbein JH, Wieczorek D, Kapp A, Jakob T, Wedi B. Generalized reactions during skin testing with clindamycin in drug hypersensitivity: a report of 3 cases and review of the literature. Contact Dermatitis 2018; 78:274-280. [DOI: 10.1111/cod.12956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/02/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Eleni Papakonstantinou
- Department of Dermatology and Allergy; Comprehensive Allergy Centre, Hannover Medical School; 30625, Hannover Germany
| | - Sabine Müller
- Department of Dermatology; Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg; 79104 Freiburg im Breisgau Germany
| | - Jan H. Röhrbein
- Department of Dermatology and Allergy; Comprehensive Allergy Centre, Hannover Medical School; 30625, Hannover Germany
| | - Dorothea Wieczorek
- Department of Dermatology and Allergy; Comprehensive Allergy Centre, Hannover Medical School; 30625, Hannover Germany
| | - Alexander Kapp
- Department of Dermatology and Allergy; Comprehensive Allergy Centre, Hannover Medical School; 30625, Hannover Germany
| | - Thilo Jakob
- Department of Dermatology; Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg; 79104 Freiburg im Breisgau Germany
- Department of Dermatology and Allergology; University Hospital Gießen (UKGM), Justus-Liebig-University Gießen; 35385 Giessen Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy; Comprehensive Allergy Centre, Hannover Medical School; 30625, Hannover Germany
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Abstract
PURPOSE OF REVIEW The aim of the present review was to discuss recent advances supporting a role of drug metabolism, and particularly of the generation of reactive metabolites, in hypersensitivity reactions to drugs. RECENT FINDINGS The development of novel mass-spectrometry procedures has allowed the identification of reactive metabolites from drugs known to be involved in hypersensitivity reactions, including amoxicillin and nonsteroidal antiinflammatory drugs such as aspirin, diclofenac or metamizole. Recent studies demonstrated that reactive metabolites may efficiently bind plasma proteins, thus suggesting that drug metabolites, rather than - or in addition to - parent drugs, may elicit an immune response. As drug metabolic profiles are often determined by variability in the genes coding for drug-metabolizing enzymes, it is conceivable that an altered drug metabolism may predispose to the generation of reactive drug metabolites and hence to hypersensitivity reactions. These findings support the potential for the use of pharmacogenomics tests in hypersensitivity (type B) adverse reactions, in addition to the well known utility of these tests in type A adverse reactions. SUMMARY Growing evidence supports a link between genetically determined drug metabolism, altered metabolic profiles, generation of highly reactive metabolites and haptenization. Additional research is required to developing robust biomarkers for drug-induced hypersensitivity reactions.
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Aung AK, Haas DW, Hulgan T, Phillips EJ. Pharmacogenomics of antimicrobial agents. Pharmacogenomics 2015; 15:1903-30. [PMID: 25495412 DOI: 10.2217/pgs.14.147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Antimicrobial efficacy and toxicity varies between individuals owing to multiple factors. Genetic variants that affect drug-metabolizing enzymes may influence antimicrobial pharmacokinetics and pharmacodynamics, thereby determining efficacy and/or toxicity. In addition, many severe immune-mediated reactions have been associated with HLA class I and class II genes. In the last two decades, understanding of pharmacogenomic factors that influence antimicrobial efficacy and toxicity has rapidly evolved, leading to translational success such as the routine use of HLA-B*57:01 screening to prevent abacavir hypersensitivity reactions. This article examines recent advances in the field of antimicrobial pharmacogenomics that potentially affect treatment efficacy and toxicity, and challenges that exist between pharmacogenomic discovery and translation into clinical use.
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Affiliation(s)
- Ar Kar Aung
- Department of General Medicine & Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
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Cherif Y, Jallouli M, Mseddi M, Turki H, Bahloul Z. Acute generalized exanthematous pustulosis induced by piroxicam: a case report. Indian J Pharmacol 2014; 46:232-3. [PMID: 24741202 PMCID: PMC3987199 DOI: 10.4103/0253-7613.129332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/30/2013] [Accepted: 01/21/2014] [Indexed: 01/05/2023] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a severe adverse cutaneous reaction characterized by an acute episode of sterile pustules over erythematous-edematous skin. The main triggering drugs are antibiotics, mainly beta-lactam and macrolides. Non-steroid anti-inflammatory drugs may rarely be responsible. We describe a case of a woman with AGEP, who presented with generalized pustulosis lesions after the use of piroxicam for renal colic. The diagnosis was confirmed by the clinical and histological correlations and the dermatosis resolved after withdrawal of the drug.
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Affiliation(s)
- Y Cherif
- Department of Internal Medicine, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Moez Jallouli
- Department of Internal Medicine, Hedi Chaker University Hospital, Sfax, Tunisia
| | - M Mseddi
- Department of Dermatology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - H Turki
- Department of Dermatology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Z Bahloul
- Department of Internal Medicine, Hedi Chaker University Hospital, Sfax, Tunisia
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