Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study

Mejía, Dolly Vanessa Rojas; Zwiener, Ricardo D.; Villa, Ricardo Cardona; Ramirez, L.; Espinosa, Diana Lucía Silva; Zanacchi, Viviana Andrea; Sosa, P; Ensina, Luís Felipe; Bianchi, Pedro Giavina; Portilho, Nathália Coelho; Aun, Marcelo Vívolo; Matos-Benavides, Edgar; Ruiz, Dalmer; Járes, Edgardo; Reyes, Carlos Daniel Serrano

doi:10.18176/jiaci.0497

Cited by 9 publications

(6 citation statements)

References 58 publications

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“…DRESS was the most common SCAR in our study population. This finding was in agreement with studies from the UK [ 2 ] and Latin America [ 14 ]. A similar trend was noted in previous Turkish studies [ 10 , 11 ].…”

Section: Discussionsupporting

confidence: 94%

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia

AlJasser

2023

Dermatology Research and Practice

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Background. Severe cutaneous adverse drug reactions (SCARs), although rare, are known to be associated with significant morbidity and mortality. SCARs include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and acute generalized exanthematous pustulosis (AGEP). Studies on SCARs are limited in Saudi Arabia. This study aims to characterize SCARs at a tertiary care center in Saudi Arabia. Methods. A cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All inpatient and emergency department consultations to dermatology were electronically reviewed during the period from January 2016 to December 2020. All patients who developed an adverse cutaneous drug reaction were enrolled. Detailed analysis was performed only for SCARs. The culprit medication was determined based on the latency period, history of previous intake of the medication, and drug notoriety. Results. There were 3050 hospital consultations to dermatology during the study period. Cutaneous adverse drug reactions constituted 253 (8.3%) cases. A total of 41 patients with SCARs were identified, accounting for 16.2% of all cutaneous drug reactions. Antibiotics and anticonvulsants were the most common causative drug groups accounting for 28 (68.3%) and 9 (22%) cases, respectively. DRESS was the most common SCAR. The latency period was the longest for DRESS and shortest for AGEP. Vancomycin was responsible for approximately a third of DRESS cases. Piperacillin/tazobactam was the most common cause for SJS/TEN and AGEP. The majority of drugs causing AGEP were antibiotics. The mortality rate was the highest in SJS/TEN (5/11 (45.5%)), followed by DRESS (1/23 (4.4%)) and AGEP (1/7 (14.3%)). Conclusion. SCARs are rare in Saudis. DRESS appears to be the most common SCAR in our region. Vancomycin is responsible for most cases of DRESS. SJS/TEN had the highest mortality rate. More studies are required to further characterize SCARs in Saudi Arabia and Arabian Gulf countries. More importantly, thorough studies of HLA associations and lymphocyte transformation tests among Arabs with SCARs are likely to further improve patient care in the Arabian Gulf region.

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Section: Discussionsupporting

confidence: 94%

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia

AlJasser

2023

Dermatology Research and Practice

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“…Penicillins were also responsible for SJS or SJS/TEN overlap in over one third of ScADRs cases [74]. Several other papers also found penicillins or other β-lactam ABs as main culprits for cADRs [77,100]. In a retrospective analysis of 608 cases in central China [68] described that ABs were responsible for both non-severe cADRs (48.0%) and severe-cADRs (22.0%) [68].…”

Section: Juniper Online Journal Of Dermatology and Cosmeticsmentioning

confidence: 98%

“…In a study at an Italian tertiary care paediatric hospital from 2010 to 2018, a very high frequency of SJS (>55%) and DRESS (>31%) was observed [87]. Rojas Mejía et al, (2021) [100] described very high rates of DRESS-DIHS (60%) in their study of ScADRs in Latin America [100]. Besides, three other studies mentioned high rates of DRESS (>30.0%) [42,74,92].…”

Section: Juniper Online Journal Of Dermatology and Cosmeticsmentioning

confidence: 99%

“…Besides, three other studies mentioned high rates of DRESS (>30.0%) [42,74,92]. Among these Lin et al, (2014) [74] and Rojas Mejia et al, (2021) [100] studies were concerning ScADRs only. Acute generalized exanthematous pustulosis (AGEP), drug-induced hypersensitivity syndrome (DIHS) or drug reaction with eosinophilia and systemic symptoms (DRESS), symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap, generalized bullous fixed drug eruption (GBFDE).…”

Section: Juniper Online Journal Of Dermatology and Cosmeticsmentioning

confidence: 99%

“…Among all the ABs, penicillins were the most implicated drug group, others being cephalosporins, sulphonamides, fluroquinolones, macrolides, glycopeptides, tetracyclines and others [42,80,93,[96][97]100]. One of the articles mentioned vancomycin induced severe cADR, red man syndrome (RMS) [83].…”

Section: Juniper Online Journal Of Dermatology and Cosmeticsmentioning

confidence: 99%

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Untitled

2023

JOJDC

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Medication-related harm or adverse drug reaction is a great global health concern today. They are frequent and, most often, devastating. With the rising incidences of drug-related adverse outcomes, it is imperative that clinicians have the knowledge and understanding of these occurrences to prevent, diagnose, and manage them properly. Skin is a very commonly affected organ system, and incidences of cutaneous adverse drug reactions are between 1-5% depending on the geographic location. Up to 60% or more of all adverse drug reactions may represent cutaneous reactions. These may fall into either of the dose-dependent or dose-independent categories. Being the most prescribed and utilized drug group, antibiotics have been implicated as one of the major drug groups causing cutaneous drug reactions. There is ample evidence that antibiotics cause severe and non-severe cutaneous adverse drug reactions. A review of the present literature was done using MEDLINE/PubMed, Google Scholar, and other search engines to gather evidence to find how extensive the problem is and how much the burden is. Which will enlighten clinicians from all backgrounds and medical students and help them deal with cutaneous adverse drug reactions more prudently.

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Multiple drugs

2022

Reactions Weekly

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Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 9 publications

References 58 publications

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia

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Multiple drugs

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