Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

J.G. Peter; R. Lehloenya; S. Dlamini; K. Risma; K.D. White; K.C. Konvinse; E.J. Phillips

doi:10.1016/j.jaip.2017.01.025

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Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

Journal article

Peer reviewed

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

J.G. Peter, R. Lehloenya, S. Dlamini, K. Risma, K.D. White, K.C. Konvinse and E.J. Phillips

The Journal of Allergy and Clinical Immunology: In Practice, Vol.5(3), pp.547-563

2017

DOI: https://doi.org/10.1016/j.jaip.2017.01.025

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Abstract

Most immune-mediated adverse drug reactions (IM-ADRs) involve the skin, and many have additional systemic features. Severe cutaneous adverse drug reactions (SCARs) are an uncommon, potentially life-threatening, and challenging subgroup of IM-ADRs with diverse clinical phenotypes, mechanisms, and offending drugs. T-cell–mediated immunopathology is central to these severe delayed reactions, but effector cells and cytokines differ by clinical phenotype. Strong HLA-gene associations have been elucidated for specific drug-SCAR IM-ADRs such as Stevens-Johnson syndrome/toxic epidermal necrolysis, although the mechanisms by which carriage of a specific HLA allele is necessary but not sufficient for the development of many IM-ADRs is still being defined. SCAR management is complicated by substantial short- and long-term morbidity/mortality and the potential need to treat ongoing comorbid disease with related medications. Multidisciplinary specialist teams at experienced units should care for patients. In the setting of SCAR, patient outcomes as well as preventive, diagnostic, treatment, and management approaches are often not generalizable, but rather context specific, driven by population HLA-genetics, the pharmacology and genetic risk factors of the implicated drug, severity of underlying comorbid disease necessitating ongoing treatments, and cost considerations. In this review, we update the basic and clinical science of SCAR diagnosis and management

Details

Title: Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice
Authors/Creators: J.G. Peter (Author/Creator) - University of Cape Town
R. Lehloenya (Author/Creator) - University of Cape Town
S. Dlamini (Author/Creator) - University of Cape Town
K. Risma (Author/Creator) - Cincinnati Children's Hospital Medical Center
K.D. White (Author/Creator) - Vanderbilt University Medical Center
K.C. Konvinse (Author/Creator) - Vanderbilt University Medical Center
E.J. Phillips (Author/Creator) - Vanderbilt University Medical Center
Publication Details: The Journal of Allergy and Clinical Immunology: In Practice, Vol.5(3), pp.547-563
Publisher: Elsevier
Identifiers: 991005544753307891
Copyright: © 2017 American Academy of Allergy, Asthma & Immunology
Murdoch Affiliation: Institute for Immunology and Infectious Diseases
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.265 Dermatology - Skin Allergies; 1.265.1140 Drug Hypersensitivity
Web Of Science research areas: Allergy; Immunology
ESI research areas: Clinical Medicine