Stevens–<scp>J</scp>ohnson syndrome and toxic epidermal necrolysis in children

Atanasković-Marković, Marina; Medjo, Biljana; Gavrović-Jankulović, Marija; Veličković, Tanja Ćirković; Nikolić, Dimitrije; Nestorovic, Branimir

doi:10.1111/pai.12121

Cited by 22 publications

(12 citation statements)

References 21 publications

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“…67---69 The sensitivity of PT in SJS/TEN is low (10.8---37.5%). 70 Late reading of intradermal test appears to be more sensitive than the PT, 65 with a negative predictive value of about 90%, 71 but is also less specific 25,67 and is uncertain. 25 LTT attempts to quantify the activation of T cells in response to the drug.…”

Section: Sjs/tenmentioning

confidence: 96%

“…Diagnosis is based on clinical history, the empirical risk of drugs to trigger SJS/TEN, and in vivo and in vitro tests of suspected drugs. 65 A detailed history of all new medications taken during the 8 weeks before the onset of the disease will be obtained, although the most important period to consider is 1---2 weeks before. 20 The challenge test is contraindicated because rechallenge may trigger a new episode of greater severity.…”

Section: Sjs/tenmentioning

confidence: 99%

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Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens–Johnson syndrome, toxic epidermal necrolysis and DRESS)

Belver

Michavila

Bobolea

et al. 2016

Allergologia et Immunopathologia

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Severe delayed drug-induced skin reactions in children are not common but potentially serious. This article describes aspects concerning the etiology, pathogenesis and clinical manifestations of these processes; it presents three paediatric cases, namely STS (Steven Johnson Syndrome), TEN (toxic epidermal necrolysis), probably related to amoxicillin/clavulanate and ibuprofen and DRESS (a drug reaction with eosinophilia and systemic symptoms) secondary to phenytoin; and in relation to them, the diagnosis and the treatment of these processes are discussed and reviewed. The AGEP (acute generalised exanthematous pustulosis) is also reviewed. The aetiological diagnosis of severe non-immediate reactions is difficult, and the value of current allergological testing is not well defined in these cases. Diagnosis is based on clinical history, the empirical risk of drugs to trigger SJS/TEN or DRESS, and the in vivo and in vitro testing of the suspect drug. Skin biopsy confirms that the clinical diagnosis and delayed hypersensitivity tests, especially the patch test and the lymphoblastic transformation test (LTT), may be important to confirm the aetiological diagnosis, in our cases emphasising the latter. These diseases can be life threatening (especially DRESS and TEN) and/or have a high rate of major complications or sequelae (SJS/TEN). The three cases described progressed well without sequelae. All were treated with corticosteroids, which is the most currently accepted treatment although the effect has not been clearly demonstrated.

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Section: Sjs/tenmentioning

confidence: 96%

Section: Sjs/tenmentioning

confidence: 99%

Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens–Johnson syndrome, toxic epidermal necrolysis and DRESS)

Belver

Michavila

Bobolea

et al. 2016

Allergologia et Immunopathologia

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“…Patch tests have been suggested to be especially useful to diagnose nonimmediate hypersensitivity to anticonvulsants and NSAIDs, but further large studies are needed to evaluate their diagnostic value .…”

Section: Diagnostic Approach To Drug Hypersensitivity In Childrenmentioning

confidence: 99%

Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

Gomes

Brockow

Kuyucu

et al. 2015

Allergy

249

336

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When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sicknesslike reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.

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“…Atanasković-Marković et al reported the case of a 9-year-old girl who, after 4 days of treatment with ibuprofen because of an upper respiratory tract infection, developed SJS with a skin rash, purplish macules, erythema and bullae. Six months later, the girl showed a positive reaction to a patch test with ibuprofen [70]. Belver et al described the case of an 11-year-old boy with aphthae of the oral mucosa who was diagnosed with SJS following treatment with amoxicillin/clavulanic acid and ibuprofen.…”

Section: Tolerability Profiles In Other Conditionsmentioning

confidence: 99%

“…of patientsDisorderTreatmentAdverse events/riskClinical outcome2007Dore J [69]32Mainly feverIbuprofen (alone or with azithromycin)Severe ocular involvement, toxic epidermal necrolysis, SJS, sepsis, pneumonia and genitourinary complicationsSequelae2013Atanasković-Marković M [70]1Upper respiratory tract infectionIbuprofenSkin rashes, purplish macules, erythema, multiple bullae and SJSResolved2015Blanca-López N [71]–Pain/fever/inflammationIbuprofen (and other drugs)Urticaria, angioedema, toxic epidermal necrolysis and SJS–2015Belver MT [68]1Otitis media with feverIbuprofen (together with amoxicillin/ clavulanic acidAphthae of oral mucosa, SJSResolved …”

Section: Tolerability Profiles In Other Conditionsmentioning

confidence: 99%

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Martino

Chiarugi

Boner

et al. 2017

Drugs

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Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.

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Stevens–Johnson syndrome and toxic epidermal necrolysis in children

Cited by 22 publications

References 21 publications

Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens–Johnson syndrome, toxic epidermal necrolysis and DRESS)

Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens–Johnson syndrome, toxic epidermal necrolysis and DRESS)

Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

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