Aetiopathogenesis of severe cutaneous adverse reactions (SCARs) in children: A 9-year experience in a tertiary care paediatric hospital setting

被引:25
作者
Liccioli, Giulia [1 ]
Mori, Francesca [1 ]
Parronchi, Paola [2 ]
Capone, Manuela [2 ]
Fili, Lucia [2 ]
Barni, Simona [1 ]
Sarti, Lucrezia [1 ]
Giovannini, Mattia [1 ]
Resti, Massimo [3 ]
Novembre, Elio M. [1 ]
机构
[1] Anna Meyer Childrens Univ Hosp, Dept Paediat, Allergy Unit, Viale Pieraccini 24, I-50100 Florence, Italy
[2] Univ Florence, Dept Clin & Expt Med, Unit Internal Med, Florence, Italy
[3] Anna Meyer Childrens Hosp, Dept Paediat, Florence, Italy
关键词
acute generalized exanthematous pustulosis; aetiopathogenesis; children; drug reaction with eosinophilia and systemic symptoms; hypersensitivity drug reactions; lymphocyte transformation tests; paediatrics; severe cutaneous adverse reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis; STEVENS-JOHNSON-SYNDROME; TOXIC EPIDERMAL NECROLYSIS; EXANTHEMATOUS PUSTULOSIS AGEP; DRUG-REACTIONS; RETROSPECTIVE ANALYSIS; SYNDROME S[!text type='JS']JS[!/text; ERUPTIONS; HYPERSENSITIVITY; EPIDEMIOLOGY; INPATIENTS;
D O I
10.1111/cea.13513
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background Severe cutaneous adverse reactions (SCARs) are delayed-type hypersensitivity reactions to drugs including as follows: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Acute Generalized Exanthematous Pustulosis (AGEP). Incidence, triggers and management of SCARs have not been investigated in large-scale epidemiological studies on children. Objective The aim of our study was to collect epidemiological, clinical and aetiological data from children with SCARs referred to our tertiary care paediatric hospital of Florence. Methods From 2010 to 2018 charts of children with diagnosis of SCAR were reviewed, and data collected during the acute phase and/or the subsequent allergy evaluation. Patients underwent patch tests, intradermal tests and lymphocyte transformation tests. All children were investigated for infectious diseases. Results Incidence of SCARs in hospitalized children was 0.32% over a 9-year period. Fifty-four children were enrolled (31 M; 23 F; median age 6.5 years): 17 cases of DRESS, 30 SJS, 3 TEN, 2 AGEP, 1 linear immunoglobulin A bullous disease (LABD) and 1 pemphigus. Twenty-eight out of 54 patients underwent drug allergy investigations, and 50% of them resulted positive. Combining clinical history and results of allergy work-up, 74% SCARs seem to be caused by drugs, 18.6% by both drugs and infections, 3.7% by infections, and 3.7% remained idiopathic. No deaths occurred. Conclusions In this study, SCARs incidence is in line with literature data. Drugs were most commonly the leading cause. Management of SCARs requires cooperation among professional figures for an early diagnosis and a prompt treatment. Mortality rate seems to be lower in children.
引用
收藏
页码:61 / 73
页数:13
相关论文
共 84 条
[11]   Drug-induced Stevens-Johnson syndrome (SJS']JS), toxic epidermal necrolysis (TEN), and SJS']JS-TEN overlap: A multicentric retrospective study [J].
Barvaliya, M. ;
Sanmukhani, J. ;
Patel, T. ;
Paliwal, N. ;
Shah, H. ;
Tripathi, C. .
JOURNAL OF POSTGRADUATE MEDICINE, 2011, 57 (02) :115-119
[12]   Stevens-Johnson syndrome and toxic epidermal necrolysis: A cross-sectional analysis of patients in an integrated allergy repository of a large health care system [J].
Blumenthal, Kimberly G. ;
Wickner, Paige G. ;
Lau, Jason J. ;
Zhou, Li .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, 2015, 3 (02) :277-+
[13]   Adverse cutaneous drug reactions in a single quaternary referral hospital [J].
Botelho, Luciane F. F. ;
Porro, Adriana M. ;
Enokihara, Milvia M. S. S. ;
Tomimori, Jane .
INTERNATIONAL JOURNAL OF DERMATOLOGY, 2016, 55 (04) :E198-E203
[14]   EAACI position paper on how to classify cutaneous manifestations of drug hypersensitivity [J].
Brockow, Knut ;
Ardern-Jones, Michael R. ;
Mockenhaupt, Maja ;
Aberer, Werner ;
Barbaud, Annick ;
Caubet, Jean-Christoph ;
Spiewak, Radoslaw ;
Torres, Maria Jose ;
Mortz, Charlotte G. .
ALLERGY, 2019, 74 (01) :14-27
[15]  
Castro-Pastrana LI, 2011, J POPUL THER CLIN PH, V18, pE106
[16]  
Chatproedprai S, 2018, DERMATOL RES PRACT, V2018, P1
[17]   An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia [J].
Choon, Siew-Eng ;
Lai, Nai-Ming .
INDIAN JOURNAL OF DERMATOLOGY VENEREOLOGY & LEPROLOGY, 2012, 78 (06) :734-739
[18]   Severe cutaneous adverse drug reactions [J].
Chung, Wen-Hung ;
Wang, Chuang-Wei ;
Dao, Ro-Lan .
JOURNAL OF DERMATOLOGY, 2016, 43 (07) :758-766
[19]   A retrospective analysis of infections and antibiotic treatment in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis [J].
Diao, Min ;
Thapa, Christina ;
Ran, Xin ;
Ran, Yuping ;
Lv, Xiaoyan .
JOURNAL OF DERMATOLOGICAL TREATMENT, 2020, 31 (01) :61-65
[20]   Cutaneous drug reactions in children: a multicentric study [J].
Dilek, Nursel ;
Ozkol, Hatice Uce ;
Akbas, Ayse ;
Kilinc, Fadime ;
Dilek, Aziz Ramazan ;
Saral, Yunus ;
Metin, Ahmet ;
Calka, Omer .
POSTEPY DERMATOLOGII I ALERGOLOGII, 2014, 31 (06) :368-371