Recurrence and Mortality Following Severe Cutaneous Adverse Reactions

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions. Both primarily develop as idiosyncratic responses to drugs, 1 resulting in extensive epidermal detachment. Recurrence has been reported in isolated cases, and the overall risk of recurrence is unknown. Given the rarity of SJS and TEN, valid inferences about recurrence rates require the study of large populations over an extended period. We examined the long-term risk of recurrence following a first SJS or TEN episode. Methods | We conducted a 10-year population-based cohort study of all Ontario residents (>13 million) hospitalized for a first episode of SJS or TEN (International Statistical Classification of Diseases, 10th Revision [ICD-10] codes L511 or L512, respectively) between April 2002 and March 2011, excluding those with any such admission in the preceding 5 years. We linked comprehensive hospitalization data (from the Canadian Institute for Health Information Discharge Abstract Database), demographic and vital statistics (from the Registered Persons Database), and physician claims (from the Ontario Health Insurance Plan) in an anonymous fashion, as done previously. 2 Patients were followed up from admission until March 31, 2012, or death. We explored SJS and TEN recurrence rates and short-term mortality using the Kaplan-Meier method, and compared patients with and without recurrent episodes using the t test, Mann-Whitney test, or χ 2 test, as appropriate. We used Cox proportional hazards regression to explore factors associated with recurrence.

The 3 Cs of Antibiotic Allergy—Classification, Cross-Reactivity, and Collaboration

“…who demonstrated that 42% of patients with SCAR were hospitalized with a subsequent episode of SJS or TEN. 108 Ex vivo diagnostics, such as T-cell enzyme linked immunospot (ELIspot) 109–116 and lymphocyte transformation testing (LTT), 94, 117–120 and flow assays may improve the sensitivity and specificity of current testing and provide additional insights into immunopathogenesis. In some cases of appropriately selected phenotypes (MPE) and implicated antibiotics (penicillin or aminopenicillin), direct oral challenge without skin testing has been safely employed to exclude non-immediate hypersensitivity.…”

Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea

“…At the same time, SJS-TEN overlap syndrome could not be separated by ICD-10. However, by using ICD-10 which has separate diagnostic codes for SJS and TEN, it reduces the risk of misclassification [26]. Second, we could not identify the causative agent for each case.…”

An effective strategy to prevent allopurinol-induced hypersensitivity by HLA typing

“…Mortality is reported as 10% in Stevens-Johnson syndrome (SJS), 25-30% in toxic epidermal necrolysis (TEN), and 10% in drug hypersensitivity syndrome. 1,2 Among the drugs commonly causing SCARs, such as allopurinol, carbamazepine, phenytoin, phenobarbital, lamotrigine, abacavir, sulfonamides, and several nonsteroidal anti-inflammatory drugs, allopurinol is one of the most frequently involved causative agents of SCARs in many countries, including Korea. 3 Allopurinol, a xanthine oxidase inhibitor, is a urate-lowering agent prescribed frequently to patients with hyperuricemia or gout.…”