Stevens-Johnson syndrome adverse cutaneous reactions

The tolerability of rofecoxib in patients with cutaneous allergic and pseudoallergic adverse reactions to non-selective NSAIDs has been confirmed in a study in 139 patients with NSAID-induced adverse reactions 60 with urticaria alone (43%), 34 with angioedema (25%), 34 with angioedema plus urticaria (2.9%), and 2 with Stevens-Johnson syndrome (1.4%) (134). They aU underwent a single-blind, placebo-controlled oral challenge with increasing doses of rofecoxib, and 138 of them tolerated it without adverse reactions. Only one had mild urticaria on the arms. Rofecoxib may be a useful alternative in patients with NSAID hypersensitivity. 

Skin reactions to mefloquine have been reviewed, in relation to 74 case reports published between 1983 and 1997 (39). Pruritus and maculopapular rash were the most common skin reactions in some studies, their approximate frequency was 4—10% for pruritus and up to 30% for non-specific maculopapular rashes. Adverse effects less commonly associated with mefloquine included urticaria, facial lesions, and cutaneous vasculitis. There was one case of Stevens-Johnson syndrome and one fatal case of toxic epidermal necrolysis. 

Allergic skin reactions occur in 1-2% of patients who take nitrofurantoin and comprise about 21% of all adverse reactions to nitrofurantoin (5,71). They often occur with other reactions, such as drug fever, lung, or hver reactions. The lesions can present as pruritus, as macular, maculopapular, or vesicular rashes, urticaria, angioedema, or erjdhema multiforme (72). The frequency of serious cutaneous reactions (erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis) after nitrofurantoin has been estimated to be 7 cases per 100 000 exposed individuals (71). 

Adverse hypersensitivity may start 1 to 8 weeks after start of drug use and clinically display as anaphylaxis, fever, rash and various cutaneous reactions (exanthema s, bullous responses, etc.), blood dyscrasias and involve multiple internal organs, including liver, kidney and lungs (Sullivan and Shear, 2001 Gomes and Demoly, 2005). Occasionally drug hypersensitivity results in very serious and life-threatening conditions, such as Steven Johnsons Syndrome (SJS) and toxic epidermal necrolysis (TEN). 

Russmann S, Kaye JA, Jick SS, Jick H (2005) Risk of cholestatic liver disease associated with flucloxacillin and fiucloxacillin prescribing habits in the UK cohort study using data from the UK General Practice Research Database. Br J Clin Pharmacol 60 76-82 Rzany B, Correia O, Kelly JP, Naldi L, Auquier A, Stem R (1999) Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy a case-control study. Study group of the international case control study on severe cutaneous adverse reactions. Lancet 353 2190-2194... 

HLA class I has been examined in 15 Japanese patients who fulfilled the diagnostic criteria for carbamazepine-induced cutaneous adverse reactions (mild in 10 and Stevens-Johnson syndrome in 5) [124 ]. HLA-B 1518, HLA-B 5901, and HLA-C 0704 alleles were associated with higher relative risks of severe cutaneous adverse reactions. The haplotype HLA-A 2402-B 5901-C 0102 carried a high relative risk of severe adverse reactions. In patients with severe cutaneous adverse reactions, the frequencies of HLA-A 1101, HLA-A 3303, HLA-B 1501, HLA-B 4403, HLA-B 5101, HLA-B 5201, HLA-C 0702, and HLA-C 1202 alleles were relatively lower than in the general population of Japanese people. The authors suggested that HLA-B 5901 may be a marker of carbamazepine-induced Stevens-Johnson syndrome in Japanese people. 

Skin Allopurinol has commonly been implicated in Stevens—Johnson syndrome and toxic epidermal necrolysis [85 ]. This association has been confirmed by an analysis from Singapore. Of 85 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis managed in Singapore from 2003 to 2007, allopurinol was implicated in 13 cases [86 ]. The HLA-B 5801 allele is associated with severe cutaneous adverse reactions caused by allopurinol in the Han Chinese population [87 ]. The association between allopurinol-related Stevens-Johnson syndrome and toxic epidermal necrolysis and HLA-B 5801 has also been confirmed in Thai and Japanese patients [88 89. ... 

A retrospective review of 462,969 adult patients was carried out to assess the risk and pattern of cutaneous adverse reactions associated with the use of PPIs. Sixty-four patients with cutaneous adverse reactions were identified within the study population, and matched with 65 subjects, who did not experience adverse events while on therapy with PPIs. The overall prevalence of cutaneous reactions was 22.6 per 100,000 treated subjects, with specific values of 20, 16,15,10 and 3 per 100,000 for lansoprazole, pantoprazole, omeprazole, rabeprazole and esomeprazole, respectively. Most cutaneous reactions were attributed to omeprazole (n = 50 78.1%). The most frequent reaction was maculo-papular rash (43.8%), but other adverse events included cases of angioedema and/or urticaria, Stevens-Johnson syndrome and toxic epidermal necrolysis, erytiiema multiforme, eczematous drug eruption, urticarial vasculitis and fixed drug eruption. None of the patients experienced cross-reactions among individual PPIs [34 ]. 

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