Antibiotic exposure is associated with cutaneous adverse events in hairy cell leukemia patients treated with purine analogues

Wang, Rebecca F.; Li, Daniel; Kuehn, Gina J.; Andritsos, Leslie A.; Kaffenberger, Benjamin H.

doi:10.1016/j.jaad.2018.07.066

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…Certain antibiotics, notably penicillin, used concomitantly with chemotherapeutic drugs in the treatment of leukaemia, were observed to be independently associated with the development of a morbilliform rash. A suggested mechanism for the pathogenesis of these cutaneous eruptions is that the profound CD4 + lymphopenia, including regulatory T cells, induced by these purine analogues results in hypersensitivity and decreased drug tolerance 23 …”

Section: The Mechanism Of Diementioning

confidence: 99%

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Tsabouri

Atanasković-Marković

2021

Pediatric Allergy Immunology

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Childhood rashes or exanthemas are common and are usually relatively benign. There are many causes of rash in children, including mainly viruses, and less often bacterial toxins, drugs, allergens and other diseases. Viral exanthema often appears while children are taking a medication in the course of a viral infection; it can mimic drug exanthema and is perceived as a drug allergy in 10% of cases. In the vast majority of cases, the distinction between virus‐induced and drug‐induced skin eruption during the acute phase is not possible. The drugs most commonly implicated are beta‐lactams (BL) and non‐steroidal anti‐inflammatory drugs (NSAIDs). Viruses, commonly Epstein‐Barr virus (EBV), human herpesvirus 6 (HHV6) and cytomegalovirus (CMV), and the bacterium, Mycoplasma pneumoniae, may cause exanthema either from the infection itself (active or latent) or because of interaction with drugs that are taken simultaneously. Determination of the exact diagnosis requires a careful clinical history and thorough physical examination. Haematological and biochemical investigations and histology are not always helpful in differentiating between the two types of exanthema. Serological and polymerase chain reaction (PCR) assays can be helpful, although a concomitant acute infection does not exclude drug hypersensitivity. A drug provocation test (DPT) is although considered the gold standard for the diagnosis and is not preferred by the patients. Skin tests are not well tolerated, and in vitro tests, such as the basophil activation test and lymphocyte transformation, are of low sensitivity and specificity and their relevance is debatable. Based on current evidence, we propose a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous eruption while receiving a drug.

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Section: The Mechanism Of Diementioning

confidence: 99%