Volume 4 Supplement 3

6th Drug Hypersensitivity Meeting (DHM 6)

Open Access

The causative drugs and the prevalence of severe bullous hypersensitivity reactions

  • Ekaterina Vertieva1,
  • Pavel Kolkhir2 and
  • Natalia Teplyuk3
Clinical and Translational Allergy20144(Suppl 3):P16

https://doi.org/10.1186/2045-7022-4-S3-P16

Published: 18 July 2014

Background

According to recent studies about 1-3% hypersensitivity reactions are accompanied by skin eruptions. Among these toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare and the most severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. TEN and SJS affecting approximately 1-4/1,000,000 annually with average reported mortality rate 25-35% (TEN), and 1-5% (SJS). The aim of this work was to study the frequency of severe bullous delayed allergic reactions, like TEN and SJS, their clinical presentations, causative drugs, treatment and the diagnostic approach required.

Method

We followed up 33 patients (7 males, 26 females) aged 21-80 years with various severe bullous dermatoses in dermatology department of our hospital.

Results

Most of the patients had drug hypersensitivity reactions (n=22) and most of them were female older than 70 years. 3 of them had TEN and 7 suffered from SJS. The causative drugs of TEN and SJS were sulfonamides (23%, n=5), NSAIDs (14%, n=3) and anticonvulsants (9%, n=2). The most common drug was sulfamethoxazole (18%). The most severe reactions were caused by sulfamethoxazole (13%), metamizole (4%) and carbamazepine (9%). Mortality rate was about 4% (n=1).

Conclusion

The results of our study indicate that TEN and SJS may occur in about 32% patients with severe bullous dermatoses. Sulfanonamides, NSAIDs and anticonvulsants are the most frequently implicated drugs. Diagnosis relies mainly on clinical symptoms together with the results of a skin biopsy. Due to the high risk of mortality, management of patients with severe bullous dermatoses, especially TEN and SJS, requires rapid identification and interruption of the culprit drug, specialized supportive care and immunomodulatory therapy.

Authors’ Affiliations

(1)
I.M. Sechenov First Moscow State Medical University
(2)
Allergy Department, I.M. Sechenov First Moscow State Medical University
(3)
Dermatology Department, I.M. Sechenov First Moscow State Medical University

Copyright

© Vertieva et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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