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A Nationwide Study of Severe Cutaneous Adverse Reactions Based on the Multicenter Registry in Korea

Authors :
Chan Sun Park
Min Suk Yang
Young Koo Jee
Young Min Ye
Seoung Ju Park
Joo-Hee Kim
Hyen Oh La
Sae Hoon Kim
Myoung Shin Kim
Hyun Jung Jin
Jae-Woo Jung
Yong Won Lee
Sang Min Lee
Hye Ryun Kang
Gyu Young Hur
Jaechun Lee
Sang-Heon Kim
Hye-Kyung Park
Suh-Young Lee
Young-Hee Nam
Jun Kyu Lee
Sujeong Kim
Jae Won Jeong
Mi-Yeong Kim
Min Gyu Kang
Min-Hye Kim
Yong Eun Kwon
James Yun
Jeong Hee Choi
Young-Il Koh
Sang Hyon Kim
Dong Yoon Kang
Da Woon Sim
Cheol Woo Kim
Yi Yeong Jeong
Jung Won Park
Seung Eun Lee
Hee-Kyoo Kim
Source :
The Journal of Allergy and Clinical Immunology: In Practice. 9:929-936.e7
Publication Year :
2021
Publisher :
Elsevier BV, 2021.

Abstract

Background Because severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) rarely occur, clinical data based on large-scale studies are still lacking. Objective To provide information on culprit drugs and clinical characteristics, including morbidity and mortality of SCARs based on a nationwide registry. Methods SCAR cases that occurred from 2010 to 2015 were recruited to the Korean SCAR registry from 34 tertiary referral hospitals. Demographics, causative drugs, causality, and clinical outcomes were collected by reviewing the medical record. Results A total of 745 SCAR cases (384 SJS/TEN cases and 361 DRESS cases) due to 149 drugs were registered. The main causative drugs were allopurinol (14.0%), carbamazepine (9.5%), vancomycin (4.7%), and antituberculous agents (6.3%). A strong preference for SJS/TEN was observed in carbonic anhydrase inhibitors (100%), nonsteroidal anti-inflammatory drugs (84%), and acetaminophen (83%), whereas dapsone (100%), antituberculous agents (81%), and glycopeptide antibacterials (78%) were more likely to cause DRESS. The mortality rate was 6.6% (SJS/TEN 8.9% and DRESS 4.2%). The median time to death was 19 days and 29 days in SJS/TEN and DRESS respectively, and 89.8% of deaths occurred within 60 days after the onset of the skin symptoms. Conclusion Allopurinol, carbamazepine, vancomycin, and antituberculous agents were the leading causes of SCARs in Korea. Some drugs preferentially caused a specific phenotype. The mortality rate of SCARs was 6.6%, and most of the deaths occurred within 2 months.

Details

ISSN :
22132198
Volume :
9
Database :
OpenAIRE
Journal :
The Journal of Allergy and Clinical Immunology: In Practice
Accession number :
edsair.doi.dedup.....7d9bf0802d8816847856d1f74da8cb96
Full Text :
https://doi.org/10.1016/j.jaip.2020.09.011