J Allergy Clin Immunol Pract. 2021;9(2):929-936.e7.
A Nationwide Study of Severe Cutaneous Adverse Reactions Based on the Multicenter Registry in Korea.
제1저자 강동윤 · 교신저자 강혜련
소속 (37)
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea.
- Department of Immunology and Rheumatology, Nepean Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea.
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
- Department of Pharmacology, Catholic University of Korea, College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
- Department of Internal Medicine, Medical school of Yeungnam University, Daegu, Korea.
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, Incheon, Korea.
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. Electronic address: helenmed@snu.ac.kr.
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.
Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Keywords
Drug hypersensitivity syndromeDrug-related side effects and adverse reactionsRegistriesRepublic of KoreaStevens-Johnson syndrome
그 밖의 정보
- 출판 형태
- Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
- 저널
- The journal of allergy and clinical immunology. In practice · eISSN 2213-2201
- 전자 출판
- 2020-09-19
- MeSH
- Allopurinol / adverse effects · Carbamazepine · Humans · Registries · Republic of Korea / epidemiology · Stevens-Johnson Syndrome* / epidemiology
- Substances
- Carbamazepine · Allopurinol