Severe Cutaneous Adverse Drug Reactions in Pediatric Patients: A Multicenter Study

Mısırlıoğlu, Emine Dibek; Güvenir, H.; Bahçeci, Semiha; Abul, Mehtap Haktanır; Can, Demet; Guc, Belgin Emine Usta; Erkoçoğlu, Mustafa; Toyran, Müge; Nacaroğlu, Hikmet Tekin; Civelek, Ersoy; Büyüktiryaki, Betül; Giniş, Tayfur; Orhan, Fazıl; Kocabaş, Can Naci

doi:10.1016/j.jaip.2017.02.013

Cited by 73 publications

(95 citation statements)

References 30 publications

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“…Patients developed symptoms and presented to physicians at 4 and 5 weeks, respectively, after the inciting medication. Previous series reported an earlier onset of antibiotic‐induced pediatric DRESS with an average time to symptoms of approximately 6‐11 days after antibiotic therapy . Our data did not support this shorter timeframe.…”

Section: Discussioncontrasting

confidence: 96%

“…Newell et al found phenytoin, carbamazepine, and phenobarbital to be the most common culprits, while other pediatric DRESS series confirmed lamotrigine and phenytoin, respectively, as the most common etiologies . In the pediatric literature, antibiotics are being increasingly reported as the primary etiology with vancomycin, amoxicillin‐clavulanic acid, and trimethoprim‐sulfamethoxazole most commonly reported …”

Section: Discussionmentioning

confidence: 99%

“…Understanding of DRESS in children is based upon case reports and small case series. The most commonly implicated drugs in children include antibiotics, namely trimethoprim‐sulfamethoxazole and vancomycin, followed by antiepileptic medications, such as lamotrigine, carbamazepine, and phenytoin . Ibuprofen, nevirapine, raltegravir, acetylsalicylic acid, griseofulvin, fluoxetine, and sulthiamine have been associated triggers in single pediatric case reports .…”

Section: Introductionmentioning

confidence: 99%

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Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Oberlin

Rahnama‐Moghadam

Alomari

et al. 2019

Pediatric Dermatology

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Background Pediatric Drug reaction with eosinophilia and systemic symptoms (DRESS) is an uncommon disease that can be difficult to diagnose. This case series and literature review highlights the clinical features of pediatric DRESS and underscores the differential diagnoses, culprit medications, and need for clinical follow‐up to detect associated autoimmune sequelae. Objective To describe the clinical and laboratory features of pediatric DRESS, identify associated culprit medications, and discuss the natural history of disease. Methods Ten cases of pediatric DRESS were identified in the electronic medical record by searching the inpatient dermatology consultation list at Indiana University between 2013 and 2018. Clinical and laboratory data were collected including demographics, differential diagnoses, culprit medications, resolution of disease, and autoimmune sequelae. Results Pediatric patients with DRESS presented at a mean age of 11.5 years and demonstrated a mean time from drug initiation to onset of symptoms of 4 weeks. The most common inciting drugs included antibiotics (62.5%) followed by antiepileptics (37.5%). Rash and transaminitis resolved by 3 weeks, and 20% of patients, all female, developed autoimmune sequelae including Hashimoto's thyroiditis and an undifferentiated connective tissue disorder and occurred at an average of 14.5 weeks after diagnosis. Limitations This was a small retrospective study of an uncommon clinical diagnosis at a single institution. Conclusions Pediatric DRESS was most commonly caused by antibiotics which are being increasingly recognized in the literature as the predominant culprit medications. The development of autoimmune sequelae is a notable consequence that can present weeks after illness and may preferentially affect female patients.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Oberlin

Rahnama‐Moghadam

Alomari

et al. 2019

Pediatric Dermatology

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“…reported one paracetamol/acetaminophen‐induced fixed drug eruption in their study . Also, in a recent publication on severe drug‐induced reactions in children, the authors reported one case of metamizole‐induced Stevens‐Johnson syndrome in a cohort of 58 patients . Apart from these patients, other recent publications do not report the case of other children presenting with a confirmed NSAID delayed reaction .…”

Section: Epidemiology and Clinical Manifestations In Different Phenotmentioning

confidence: 90%

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

Cavkaytar

Toit

Caimmi

2018

Pediatric Allergy Immunology

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Non-steroidal anti-inflammatory drugs (NSAIDs) are available as over-the-counter drugs, and they are commonly used in children for their antipyretic, analgesic, and anti-inflammatory effects. NSAIDs are among the most frequently reported drugs associated with hypersensitivity reactions and even with anaphylaxis. A complete evaluation of the patients based on reported clinical manifestations, timing of the reaction, the presence of underlying disease, and reactions to other NSAIDs allows clinicians to stratify children with a history of reaction to NSAIDs. Although NSAID-induced hypersensitivity reactions have mainly been investigated in adults, recent studies have aimed to explore their epidemiology in the pediatric population. This review will cover the current understanding of clinical manifestations, the risk factors, and the different phenotypes of NSAID-induced hypersensitivity reactions with a comprehensive overview of the epidemiologic data from past to present and the practical approach to the management of NSAID hypersensitivity in children and adolescents.

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“…Although AGEP is categorized as a severe cutaneous adverse reaction (SCAR), it has the mildest manifestation and favorable prognosis, also in children [2]. The rash is often associated with fever and neutrophil leukocytosis (> 7 × 10 9 /L) or mild eosinophilia.…”

Section: Introductionmentioning

confidence: 99%

The First Pediatric Case of Acute Generalized Exanthematous Pustulosis Caused by Hydroxychloroquine

et al. 2019

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Introduction: Acute generalized exanthematous pustulosis (AGEP) is a generalized, non-follicular sterile pustular rash, categorized as a severe cutaneous adverse reaction, which usually has a favorable prognosis. In a majority of cases (90%), AGEP is drug induced and different drugs are reported as cause of AGEP. Hydroxychloroquine (HCQ) is an antimalarial drug that is also used in some dermatologic and rheumatic diseases due to its immunosuppressive actions. Some cases of AGEP induced by HCQ are reported in literature but only in adults. Materials, Methods and Results: We describe the first case of AGEP caused by HCQ in a child affected by juvenile Sjögren syndrome. After withdrawal of HCQ and subsequent administration, the patient experienced the same cutaneous reaction. An allergy work-up was performed and patch test showed an ectopic flare of AGEP eruption. Conclusion: Our patient represents the first pediatric case of AGEP to HCQ, posing such a drug as a possible trigger also in children. Therefore, an accurate drug medical history is mandatory in order to rule out potential drug reactions when facing a sudden rash.

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Severe Cutaneous Adverse Drug Reactions in Pediatric Patients: A Multicenter Study

Cited by 73 publications

References 30 publications

Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

The First Pediatric Case of Acute Generalized Exanthematous Pustulosis Caused by Hydroxychloroquine

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