The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.29021/spdv.78.1.1161 |
Resumo: | Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction. According on the culprit drug(s), imputability can be confirmed by patch test (PT). Our objective was to evaluate the value of PT in DRESS in the last 10 years, in comparison with our study in the preceding 10 years. Material & Methods: From 2009 to 2018, patients with DRESS performed PT at the Dermatology Department of Coimbra University Hospital, with the main culprit drug(s) and all drugs administered concomitantly or suspected of inducing DRESS flares. Drugs at 1% - 10% pet (Chemotechnique diagnostics®) or from a commercial preparation diluted at 10% pet were patch tested. Results: We studied 41 patients (20 male/ 21 female, mean age 53 years). The main culprits were allopurinol (n=15), antiepileptics (n=14), trimethoprim/ sulfamethoxazole (n=4), salazopyrine (n=3), diclofenac (n=2), antiretrovirals, ezetimibe/simvastatin and strontium ranelate (1 each). In 15 patients other drugs (n=18) were suspected of worsening DRESS, amoxicillin (n=8), ciprofloxacin (n=2), cefoxitin (n=2), levofloxacin, ceftriaxone, ceftazidime, vancomycin, acyclovir and metamizole (1 each). A positive PT to the culprit drug was observed in 10 patients (24.3%), all to antiepileptics. All patients tested for alopurinol had negative results. Positive reactions were observed to drugs related with flares in 12/18 suspected drugs (67%), but not to quinolones. Conclusion: Results were similar to the study conducted 10 years before when 18/56 (32.1%) patients had positive PT, mostly to carbamazepine and other anticonvulsants. Distinct from our previous study, when no tests were performed with the antibiotic series or other drugs used after the initiation of DRESS, we showed that PT can be a valuable tool to diagnose co-sensitisation in DRESS and emphasise the importance of testing all medications taken during the whole episode, even when PT has no value for the main culprit, like allopurinol. Recognising a co-sensitisation can prevent a new DRESS induced by the second drug. |
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The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years AfterA Importância dos Testes Epicutâneos nos Episódios de DRESS: Estudo Comparativo 10 Anos DepoisDrug Hypersensitivity/diagnosisEosinophilia/diagnosisExanthema/diagnosisPatch TestsEosinofilia/diagnósticoExanthema/diagnósticoHipersensibilidade a Fármacos/diagnósticoTestes EpicutâneosIntroduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction. According on the culprit drug(s), imputability can be confirmed by patch test (PT). Our objective was to evaluate the value of PT in DRESS in the last 10 years, in comparison with our study in the preceding 10 years. Material & Methods: From 2009 to 2018, patients with DRESS performed PT at the Dermatology Department of Coimbra University Hospital, with the main culprit drug(s) and all drugs administered concomitantly or suspected of inducing DRESS flares. Drugs at 1% - 10% pet (Chemotechnique diagnostics®) or from a commercial preparation diluted at 10% pet were patch tested. Results: We studied 41 patients (20 male/ 21 female, mean age 53 years). The main culprits were allopurinol (n=15), antiepileptics (n=14), trimethoprim/ sulfamethoxazole (n=4), salazopyrine (n=3), diclofenac (n=2), antiretrovirals, ezetimibe/simvastatin and strontium ranelate (1 each). In 15 patients other drugs (n=18) were suspected of worsening DRESS, amoxicillin (n=8), ciprofloxacin (n=2), cefoxitin (n=2), levofloxacin, ceftriaxone, ceftazidime, vancomycin, acyclovir and metamizole (1 each). A positive PT to the culprit drug was observed in 10 patients (24.3%), all to antiepileptics. All patients tested for alopurinol had negative results. Positive reactions were observed to drugs related with flares in 12/18 suspected drugs (67%), but not to quinolones. Conclusion: Results were similar to the study conducted 10 years before when 18/56 (32.1%) patients had positive PT, mostly to carbamazepine and other anticonvulsants. Distinct from our previous study, when no tests were performed with the antibiotic series or other drugs used after the initiation of DRESS, we showed that PT can be a valuable tool to diagnose co-sensitisation in DRESS and emphasise the importance of testing all medications taken during the whole episode, even when PT has no value for the main culprit, like allopurinol. Recognising a co-sensitisation can prevent a new DRESS induced by the second drug.Introdução: A reação adversa a fármacos com eosinofilia e sintomas sistémicos (DRESS) é uma reação medicamentosa cutânea grave. Dependendo do(s) fármaco(s) envolvido(s), a sua imputabilidade pode ser confirmada por testes epicutâneos (TE). O objetivo foi avaliar o papel dos TE nos DRESS nos últimos 10 anos e comparar com o estudo prévio, 10 anos antes. Material e Métodos: Entre o período de 2009-2018 os doentes com o diagnóstico de DRESS realizaram TE no Serviço de Dermatologia do Centro Hospitalar e Universitário de Coimbra. Foram testados os principais fármacos imputáveis, assim como os iniciados posteriormente, e suspeitos de desencadear um agravamento do quadro. Os princípios ativos foram testados 1% - 10% vas (Chemotechnique diagnostics®), ou a partir de uma preparação comercial diluída a 10% vas. Resultados: O estudo incluiu 41 pacientes (20 homens, 21 mulheres, idade média 53 anos). Os principais fármacos envolvidos foram: alopurinol (n=15), antiepiléticos (n=14), sulfametoxazole-trimetoprim (n=4), salazopirina (n=3), diclofenac (n=2) e antirretrovirais, ezetimibe-sinvastatina e ranelato de estrôncio, 1 cada. Em 15 doentes, outros fármacos (n=18) foram suspeitos de agravar o episódio de DRESS: amoxicilina (n=8), ciprofloxacina (n=2), cefoxitina (n=2) e levofloxacina, ceftriaxone, ceftazidime, vancomicina, aciclovir e metamizol (1 de cada). Obteve-se uma positividade ao fármaco principal em 10 doentes (24,3%), todas relacionadas com antiepiléticos. Todos os doentes testados para o alopurinol obtiveram resultados negativos. A positividade para os fármacos associados a agravamento clínico foi de 67% (12/18), sem nenhuma positividade para as quinolonas. Conclusão: Globalmente os resultados foram similares aos obtidos no estudo anterior, no qual 18/56 (32,1%) doentes obtiveram um resultado positivo no TE, com resposta positiva maioritariamente à carbamazepina e outros anticonvulsivantes. Diferentemente do estudo prévio, onde não foram testados fármacos administrados após o início da toxidermia, mostramos que os TE têm um papel importante no diagnóstico da cossensibilização, reforçando a importância de testar todos os medicamentos tomados durante o episódio. O reconhecimento de uma cossensibilização pode prevenir um novo DRESS desencadeada por um fármaco secundário.Sociedade Portuguesa de Dermatologia e Venereologia2020-05-06T00:00:00Zjournal articleinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.29021/spdv.78.1.1161oai:ojs.revista.spdv.com.pt:article/1161Journal of the Portuguese Society of Dermatology and Venereology; Vol 78 No 1 (2020): January - March; 25-29Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 78 n. 1 (2020): Janeiro - Março; 25-292182-24092182-2395reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spdv.com.pt/index.php/spdv/article/view/1161https://doi.org/10.29021/spdv.78.1.1161https://revista.spdv.com.pt/index.php/spdv/article/view/1161/818Morgado, Francisca JácomeSantiago, LuísGonçalo, Margaridainfo:eu-repo/semantics/openAccess2022-10-06T12:35:14Zoai:ojs.revista.spdv.com.pt:article/1161Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:11:12.394626Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After A Importância dos Testes Epicutâneos nos Episódios de DRESS: Estudo Comparativo 10 Anos Depois |
title |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After |
spellingShingle |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After Morgado, Francisca Jácome Drug Hypersensitivity/diagnosis Eosinophilia/diagnosis Exanthema/diagnosis Patch Tests Eosinofilia/diagnóstico Exanthema/diagnóstico Hipersensibilidade a Fármacos/diagnóstico Testes Epicutâneos |
title_short |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After |
title_full |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After |
title_fullStr |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After |
title_full_unstemmed |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After |
title_sort |
The Importance of Patch Testing in Drug Reaction with Eosinophilia and Systemic Symptoms: 10 Years After |
author |
Morgado, Francisca Jácome |
author_facet |
Morgado, Francisca Jácome Santiago, Luís Gonçalo, Margarida |
author_role |
author |
author2 |
Santiago, Luís Gonçalo, Margarida |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Morgado, Francisca Jácome Santiago, Luís Gonçalo, Margarida |
dc.subject.por.fl_str_mv |
Drug Hypersensitivity/diagnosis Eosinophilia/diagnosis Exanthema/diagnosis Patch Tests Eosinofilia/diagnóstico Exanthema/diagnóstico Hipersensibilidade a Fármacos/diagnóstico Testes Epicutâneos |
topic |
Drug Hypersensitivity/diagnosis Eosinophilia/diagnosis Exanthema/diagnosis Patch Tests Eosinofilia/diagnóstico Exanthema/diagnóstico Hipersensibilidade a Fármacos/diagnóstico Testes Epicutâneos |
description |
Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction. According on the culprit drug(s), imputability can be confirmed by patch test (PT). Our objective was to evaluate the value of PT in DRESS in the last 10 years, in comparison with our study in the preceding 10 years. Material & Methods: From 2009 to 2018, patients with DRESS performed PT at the Dermatology Department of Coimbra University Hospital, with the main culprit drug(s) and all drugs administered concomitantly or suspected of inducing DRESS flares. Drugs at 1% - 10% pet (Chemotechnique diagnostics®) or from a commercial preparation diluted at 10% pet were patch tested. Results: We studied 41 patients (20 male/ 21 female, mean age 53 years). The main culprits were allopurinol (n=15), antiepileptics (n=14), trimethoprim/ sulfamethoxazole (n=4), salazopyrine (n=3), diclofenac (n=2), antiretrovirals, ezetimibe/simvastatin and strontium ranelate (1 each). In 15 patients other drugs (n=18) were suspected of worsening DRESS, amoxicillin (n=8), ciprofloxacin (n=2), cefoxitin (n=2), levofloxacin, ceftriaxone, ceftazidime, vancomycin, acyclovir and metamizole (1 each). A positive PT to the culprit drug was observed in 10 patients (24.3%), all to antiepileptics. All patients tested for alopurinol had negative results. Positive reactions were observed to drugs related with flares in 12/18 suspected drugs (67%), but not to quinolones. Conclusion: Results were similar to the study conducted 10 years before when 18/56 (32.1%) patients had positive PT, mostly to carbamazepine and other anticonvulsants. Distinct from our previous study, when no tests were performed with the antibiotic series or other drugs used after the initiation of DRESS, we showed that PT can be a valuable tool to diagnose co-sensitisation in DRESS and emphasise the importance of testing all medications taken during the whole episode, even when PT has no value for the main culprit, like allopurinol. Recognising a co-sensitisation can prevent a new DRESS induced by the second drug. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-05-06T00:00:00Z |
dc.type.driver.fl_str_mv |
journal article info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.29021/spdv.78.1.1161 oai:ojs.revista.spdv.com.pt:article/1161 |
url |
https://doi.org/10.29021/spdv.78.1.1161 |
identifier_str_mv |
oai:ojs.revista.spdv.com.pt:article/1161 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spdv.com.pt/index.php/spdv/article/view/1161 https://doi.org/10.29021/spdv.78.1.1161 https://revista.spdv.com.pt/index.php/spdv/article/view/1161/818 |
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info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Dermatologia e Venereologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Dermatologia e Venereologia |
dc.source.none.fl_str_mv |
Journal of the Portuguese Society of Dermatology and Venereology; Vol 78 No 1 (2020): January - March; 25-29 Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 78 n. 1 (2020): Janeiro - Março; 25-29 2182-2409 2182-2395 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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