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Vallejo-Yagüe E, Martinez-De la Torre A, Mohamad OS, Sabu S, Burden AM. Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients. J Clin Med 2022; 11:397. [PMID: 35054090 PMCID: PMC8780223 DOI: 10.3390/jcm11020397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.
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Affiliation(s)
- Enriqueta Vallejo-Yagüe
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Adrian Martinez-De la Torre
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Omar S Mohamad
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Shweta Sabu
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Andrea M Burden
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
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Soria A, Amsler E, Bernier C, Milpied B, Tétart F, Morice C, Dezoteux F, Ferrier-Le Bouedec MC, Barbaud A, Staumont-Sallé D, Assier H. DRESS and AGEP Reactions to Iodinated Contrast Media: A French Case Series. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3041-3050. [PMID: 33757916 DOI: 10.1016/j.jaip.2021.02.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Drug reactions with eosinophilia and systemic symptoms (DRESSs) and acute generalized exanthematous pustulosis (AGEP) are potentially severe cutaneous adverse drug reactions. OBJECTIVE To describe the clinical findings and sensitization profiles of DRESS and AGEP patients who had been administered iodinated contrast media (ICM). METHODS All adult patients in the dermatologist's French Investigators for Skin Adverse Reactions to Drugs (FISARD) network diagnosed with a DRESS or AGEP highly suspected to have been caused by an ICM were included retrospectively. RESULTS Thirteen DRESS patients and 19 AGEP patients who had been administered ICM were included, and the median delay in DRESS and AGEP occurrence after ICM administration was short, 4 and 1 days, respectively. Five AGEP patients had systemic involvement. A high cosensitization rate (46%) was observed among the DRESS patients, mainly with beta-lactam antibiotics. Overall, 77% of our patients were sensitized to several ICM. Patch tests identified the suspected ICM for 21 cases (72%). The retrospective nature, the limited number of subjects, the absence of a control group of healthy individuals, and the lack of detailed information on previous exposure to sensitizing drugs are limitations of this study. CONCLUSIONS We report a large series of DRESSs and AGEPs related to ICM administration. Skin tests appear useful for diagnosis and potentially to identify alternative ICM.
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Affiliation(s)
- Angèle Soria
- Sorbonne Universités, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Centre d'Immunologie et des Maladies Infectieuses, INSERM U1135, Paris, France.
| | - Emmanuelle Amsler
- Sorbonne Universités, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - Claire Bernier
- Service de Dermatologie, Hôpital Hôtel Dieu, CHU Nantes, France
| | | | - Florence Tétart
- Clinique dermatologique CHU de Rouen et Centre Erik Satie, Allergologie CHU Rouen, France
| | | | | | | | - Annick Barbaud
- Sorbonne Universités, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | | | - Haudrey Assier
- Service de Dermatologie, Hôpital Henri Mondor, APHP, Créteil, France
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Allergic-like contrast media reaction management in children. Pediatr Radiol 2018; 48:1688-1694. [PMID: 30242426 DOI: 10.1007/s00247-018-4241-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
The use of contrast materials as part of imaging examinations is common in children of all ages, as these compounds increase image contrast, lesion detection and lesion characterization. Though modern iodinated, gadolinium-based and ultrasound microbubble contrast materials generally are quite safe, acute physiological and allergic-like reactions are possible. The majority of acute contrast reactions in children are mild and self-limited; however, life-threatening reactions can occur. It is our obligation as radiologists to recognize and manage these adverse reactions. The objective of this article is to review the frequency, manifestations and appropriate treatment of acute contrast reactions in the pediatric population.
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Kim SH, Lee SY, Choi YH, Kim CH, Hyun IK, Choi JH. Radiocontrast media-induced acute generalized exanthematous pustulosis: A safe administration of alternative radiocontrast media using patch tests. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.5.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sun-Hyung Kim
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seung-Youn Lee
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Young-Hee Choi
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Cheol-Hong Kim
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - In-Kyu Hyun
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Velter C, Schissler C, Moulinas C, Tebacher-Alt M, Siedel JM, Cribier B, Lipsker D. Acute generalized exanthematous pustulosis caused by an iodinated contrast radiocontrast medium for computed tomography arthrography of the knee. Contact Dermatitis 2017; 76:371-373. [DOI: 10.1111/cod.12724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/04/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Charles Velter
- Department of Dermatology; Universite de Strasbourg Faculte de Medecine; Strasbourg 67085 France
| | - Catherine Schissler
- Department of Dermatology; Universite de Strasbourg Faculte de Medecine; Strasbourg 67085 France
| | - Chloé Moulinas
- Department of Dermatology; Universite de Strasbourg Faculte de Medecine; Strasbourg 67085 France
| | - Martine Tebacher-Alt
- Faculte de Medecine, Department of Pharmacovigilance, Centre Regional de Pharmacovigilance et d'Information sur les Medicaments Strasbourg, Universite de Strasbourg; Strasbourg 67085 France
| | - Jean-Marie Siedel
- Department of Radiology, Cabinet de Radiologie; 67000 Strasbourg France
| | - Bernard Cribier
- Department of Dermatology; Universite de Strasbourg Faculte de Medecine; Strasbourg 67085 France
| | - Dan Lipsker
- Department of Dermatology; Universite de Strasbourg Faculte de Medecine; Strasbourg 67085 France
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Delayed Adverse Reactions to the Parenteral Administration of Iodinated Contrast Media. AJR Am J Roentgenol 2014; 203:1163-70. [DOI: 10.2214/ajr.13.12310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kostopoulos T, Krishna S, Brinster N, Ortega‐Loayza A. Acute generalized exanthematous pustulosis: atypical presentations and outcomes. J Eur Acad Dermatol Venereol 2014; 29:209-214. [DOI: 10.1111/jdv.12721] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/28/2014] [Indexed: 12/11/2022]
Affiliation(s)
- T.C. Kostopoulos
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - S.M. Krishna
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - N.K. Brinster
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - A.G. Ortega‐Loayza
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
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Nonimmediate hypersensitivity reactions to iodinated contrast media. Curr Opin Allergy Clin Immunol 2013; 13:345-53. [DOI: 10.1097/aci.0b013e328362b926] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim SJ, Lee T, Lee YS, Bae YJ, Cho YS, Moon HB, Kim TB. Acute generalized exanthematous pustulosis caused by radiocontrast media. Ann Allergy Asthma Immunol 2011; 105:492-3. [PMID: 21130392 DOI: 10.1016/j.anai.2010.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/27/2010] [Accepted: 10/03/2010] [Indexed: 10/18/2022]
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Acute generalized exanthematous pustulosis: the first pediatric case caused by a contrast agent. Ann Allergy Asthma Immunol 2010; 105:242-3. [PMID: 20800793 DOI: 10.1016/j.anai.2010.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 06/23/2010] [Accepted: 06/25/2010] [Indexed: 01/02/2023]
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Choi MJ, Kim HS, Park HJ, Park CJ, Lee JD, Lee JY, Kim HO, Park YM. Clinicopathologic manifestations of 36 korean patients with acute generalized exanthematous pustulosis: a case series and review of the literature. Ann Dermatol 2010; 22:163-9. [PMID: 20548906 DOI: 10.5021/ad.2010.22.2.163] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/14/2010] [Accepted: 02/01/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Acute generalized exanthematous pustulosis (AGEP) is a rare and severe subtype of drug eruption, characterized by acute, extensive, non-follicular, sterile pustules on an erythematous background, accompanied by fever and leukocytosis. OBJECTIVE The purpose of this study was to characterize AGEP in Korean patients in terms of clinical, laboratory, and pathologic findings. METHODS Thirty-six patients (M:F=17:19) with AGEP were identified from an extensive review of medical records over a 15 year period. All patient cases were confirmed by biopsy and fulfilled the diagnostic criteria. RESULTS The patient ages ranged from 4~80 years (37.6+/-19.4). The incubation period was 1~23 days. The duration of disease was 5~14 days. Neutrophilia (36/36), high CRP (14/36), and eosinophilia (30/36) were common laboratory findings. A history of drug administration existed in 23 of 36 patients; herbal medications, lacquers and radiocontrast media were the unique causative drugs. Spongioform subcorneal or intraepidermal pustules in the epidermis was observed in all patients. Thirty-six patients were subdivided into 2 groups: group A (n=23) was strongly associated with known agents; and group B (n=13) had no identified causative agents. There was no significant difference between the 2 groups. CONCLUSION OUR RESULTS DEMONSTRATE THE CHARACTERISTIC FEATURES OF AGEP IN KOREAN PATIENTS AS FOLLOWS: lower identification of causative agents; herbal medications, lacquers, and radiocontrast media were the main causative agents; and no significant differences existed between the 2 groups.
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Affiliation(s)
- Min Jee Choi
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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