Management of Nonimmediate Hypersensitivity Reactions to Drugs - 12/07/14

Doi : 10.1016/j.iac.2014.04.012

Jean-Claude Roujeau, MD ^a,^b,^⁎ , Cynthia Haddad, PharmD ^b,^c, Maren Paulmann, Dipl.Biol ^b,^d, Maja Mockenhaupt, MD ^b,^d
^a Université Paris-Est Créteil, France
^b RegiSCAR Network
^c Reference Center for Blistering Diseases, Hôpital Henri Mondor, Créteil, France
^d Department of Dermatology, Dokumentationszentrum schwerer Hautreaktionen (dZh), Medical Center–University of Freiburg, Hauptstr 7, Freiburg 79104, Germany

^∗Corresponding author. 19 Avenue d’Alembert, Antony 92160, France.

Résumé

Nonimmediate hypersensitivity to drugs has a huge diversity of clinical presentations affecting exclusively or predominantly a single organ (most often the skin) or multiple organs. The latter is the rule with drug reaction with eosinophilia and systemic symptoms, and with drug-induced vasculitis. The management includes a dozen successive steps. Finally, the patient should be provided clear information on the suspected cause of the reaction, recommendations for follow-up after severe reactions associated with a risk of sequelae, and clear recommendations for future use of medications. Pharmacovigilance networks should be informed.

Le texte complet de cet article est disponible en PDF.

Keywords : Drug-allergic liver injury (DALI), Drug-induced nephritis (DIN), Drug-induced vasculitis, Drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN)

Plan

	Disclosure: J.C. Roujeau and M. Mockenhaupt had/have financial links with several pharmaceutical companies that are detailed elsewhere. They consider that such links, related to causality of medications in severe cutaneous adverse reactions, do not affect the present topic.
	J.C. Roujeau: For the past 5 years, Punctual expertise of cases of SCAR for: AB-Science, Negma, Johnson & Johnson, Hoffman La Roche, Boehringer-Ingelheim; Safety boards: Vertex (2008–2011), OM-Pharma (2008–2012), Servier (2009–2011), Janssen (2010–2012), Boehringer-Ingelheim (2010–2013), Menarini (2012), Pfizer (2013); Expert witness in 5 cases of litigation in the United States concerning McNeil Consumers/Johnson & Johnson; Research: member of the RegiSCAR International study group funded in France by GSK, Novartis, Boehringer Ingelheim, OM-Pharma, Science & Technologie, Astellas Pharma.
	M. Mockenhaupt: For Expert panels and advisory boards: Vertex (2008–2011), Merck/MSD (since 2009), Boehringer-Ingelheim (since 2013), Pfizer (since 2013); Expert witness in 5 cases of litigation in the United States concerning McNeil Consumers/Johnson & Johnson; Research: coordinator of the RegiSCAR International study group funded in Germany by Berlin Chemie/Germany; Cephalon/USA; Grünenthal/Germany; GSK/UK; MSD Sharpe & Dohme/Germany; Negma/France; Novartis/Spain and USA; Pfizer/USA.