Aetiopathogenesis of severe cutaneous adverse reactions (SCARs) in children: A 9-year experience in a tertiary care paediatric hospital setting.
Acute Generalized Exanthematous Pustulosis
/ epidemiology
Adolescent
Adrenal Cortex Hormones
/ therapeutic use
Analgesics
/ therapeutic use
Anti-Bacterial Agents
/ adverse effects
Anti-Inflammatory Agents, Non-Steroidal
/ adverse effects
Anticonvulsants
/ adverse effects
Child
Child, Preschool
Drug Hypersensitivity Syndrome
/ epidemiology
Female
Hospitals, Pediatric
Humans
Immunoglobulins, Intravenous
/ therapeutic use
Immunologic Factors
/ therapeutic use
Incidence
Infant
Intradermal Tests
Italy
/ epidemiology
Linear IgA Bullous Dermatosis
/ epidemiology
Lymphocyte Activation
Male
Patch Tests
Pemphigus
/ epidemiology
Retrospective Studies
Stevens-Johnson Syndrome
/ epidemiology
Tertiary Care Centers
Stevens-Johnson syndrome
acute generalized exanthematous pustulosis
aetiopathogenesis
children
drug reaction with eosinophilia and systemic symptoms
hypersensitivity drug reactions
lymphocyte transformation tests
paediatrics
severe cutaneous adverse reactions
toxic epidermal necrolysis
Journal
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
ISSN: 1365-2222
Titre abrégé: Clin Exp Allergy
Pays: England
ID NLM: 8906443
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
16
05
2019
revised:
04
10
2019
accepted:
09
10
2019
pubmed:
15
10
2019
medline:
24
6
2021
entrez:
15
10
2019
Statut:
ppublish
Résumé
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. 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. 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. 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. 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.
Sections du résumé
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.
Substances chimiques
Adrenal Cortex Hormones
0
Analgesics
0
Anti-Bacterial Agents
0
Anti-Inflammatory Agents, Non-Steroidal
0
Anticonvulsants
0
Immunoglobulins, Intravenous
0
Immunologic Factors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
61-73Informations de copyright
© 2019 John Wiley & Sons Ltd.
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