Cutaneous adverse reactions to clindamycin: results of skin tests and oral exposure

In pediatric patients, severe cutaneous adverse reactions (SCARs) frequently occur in the course of acute illnesses, mostly infections, which are usually treated with antibiotics or analgesics. The drug provocation test (DPT) is contraindicated in such situations, due to the risk of triggering a new severe reaction. As a consequence, lifelong avoidance is recommended. However, causation is uncertain in most cases. The dilemma arises when avoiding the drug is not harmless for the patient. We have attended three patients who were referred to our pediatric allergy unit with a history of SCAR related in time to simultaneous use of paracetamol and ibuprofen. Medical records and images of the patients were reviewed with the assistance of a dermatologist, and alternative diagnoses were considered in both cases. The ALDEN score for implicated drugs was calculated. After considering a high probability of ibuprofen tolerance and obtaining informed consent from the patients, we performed a sequential allergy workup including in vitro tests, skin tests, and finally DPT in two of the patients, confirming ibuprofen tolerance. In conclusion, although generally contraindicated, DPT may be considered for some useful drugs after careful evaluation of the risk–benefit balance, preceded by a sequential study including in vitro and skin tests.

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Faculty Opinions recommendation of Sequelae in 145 patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: survey conducted by the Asian Research Committee on Severe Cutaneous Adverse Reactions (ASCAR).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725328660.793504301 ◽

2015 ◽

Author(s):

Rannakoe Lehloenya

Keyword(s):

Drug Reaction ◽

Adverse Reactions ◽

Hypersensitivity Syndrome ◽

Research Committee ◽

Drug Induced ◽

Severe Cutaneous Adverse Reactions ◽

Systemic Symptoms ◽

Cutaneous Adverse Reactions

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Role of in vivo and in vitro Tests in the Diagnosis of Severe Cutaneous Adverse Reactions (SCAR) to Drug

Current Pharmaceutical Design ◽

10.2174/1381612825666191107104126 ◽

2019 ◽

Vol 25 (36) ◽

pp. 3872-3880 ◽

Cited By ~ 3

Author(s):

Marcel M. Bergmann ◽

Jean-Christoph Caubet

Keyword(s):

Adverse Reactions ◽

Lymphocyte Transformation ◽

Stevens Johnson Syndrome ◽

In Vitro Tests ◽

High Morbidity ◽

Patch Tests ◽

Severe Cutaneous Adverse Reactions ◽

Cutaneous Adverse Reactions

Severe cutaneous adverse reactions (SCAR) are life-threatening conditions including acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Diagnosis of causative underlying drug hypersensitivity (DH) is mandatory due to the high morbidity and mortality upon re-exposure with the incriminated drug. If an underlying DH is suspected, in vivo test, including patch tests (PTs), delayed-reading intradermal tests (IDTs) and in vitro tests can be performed in selected patients for which the suspected culprit drug is mandatory, or in order to find a safe alternative treatment. Positivity of in vivo and in vitro tests in SCAR to drug varies depending on the type of reaction and the incriminated drugs. Due to the severe nature of these reactions, drug provocation test (DPT) is highly contraindicated in patients who experienced SCAR. Thus, sensitivity is based on positive test results in patients with a suggestive clinical history. Patch tests still remain the first-line diagnostic tests in the majority of patients with SCAR, followed, in case of negative results, by delayed-reading IDTs, with the exception of patients with bullous diseases where IDTs are still contra-indicated. In vitro tests have shown promising results in the diagnosis of SCAR to drug. Positivity is particularly high when the lymphocyte transformation test (LTT) is combined with cytokines and cytotoxic markers measurement (cyto-LTT), but this still has to be confirmed with larger studies. Due to the rarity of SCAR, large multi-center collaborative studies are needed to better study the sensitivity and specificity of in vivo and in vitro tests.

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In Vitro Immunologic Tests in Severe Cutaneous Adverse Reactions (SCARs)

Current Immunology Reviews ◽

10.2174/157339551101150417102232 ◽

2015 ◽

Vol 11 (1) ◽

pp. 33-42 ◽

Cited By ~ 1

Author(s):

Grzegorz Porebski ◽

Laurence Valeyrie-Allanore ◽

Francois Berrehar ◽

Sabine Gouvello

Keyword(s):

Adverse Reactions ◽

Severe Cutaneous Adverse Reactions ◽

Cutaneous Adverse Reactions ◽

Immunologic Tests

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Genetic susceptibilities and prediction modeling of carbamazepine and allopurinol-induced severe cutaneous adverse reactions in Vietnamese

Pharmacogenomics ◽

10.2217/pgs-2019-0146 ◽

2020 ◽

Author(s):

Dinh van Nguyen ◽

Hieu Chi Chu ◽

Christopher Vidal ◽

Richard B Fulton ◽

Nguyet Nhu Nguyen ◽

...

Keyword(s):

Adverse Reactions ◽

Surrogate Marker ◽

Hypersensitivity Syndrome ◽

Stevens Johnson Syndrome ◽

Strongly Correlated ◽

Drug Induced ◽

Johnson Syndrome ◽

Severe Cutaneous Adverse Reactions ◽

Systemic Symptoms ◽

Cutaneous Adverse Reactions

Aims: To determine genetic susceptibility markers for carbamazepine (CBZ) and allopurinol-induced severe cutaneous adverse reactions (SCARs) in Vietnamese. Methods: A case control study was performed involving 122 patients with CBZ or allopurinol induced SCARs and 120 drug tolerant controls. Results: HLA-B*58:01 was strongly associated with allopurinol-induced SCARs and strongly correlated with SNP rs9263726. HLA-B*15:02 was associated with CBZ-induced Stevens–Johnson syndrome/toxic epidermal necrolysis but not with drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms. No association was found between HLA-A*31:01 and CBZ-induced SCARs. HLA-B*58:01 and rs3909184 allele A with renal insufficiency were shown to increase the risk of allopurinol-induced SCARs. Conclusion: HLA-B*58:01 and HLA-B*15:02 confer susceptibility to allopurinol-induced SCARs and CBZ-induced SJS/TEN in Vietnamese. Single nucleotide polymorphism rs9263726 can be used as a surrogate marker in identifying HLA-B*58:01.

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