Management of severe drug reactions: a retrospective monocentric analysis

Abstract

In contrast to the classic frequently seen drug eruptions, the rare severe drug reactions such as acute generalized exanthematous pustulosis (AGEP), erythema multiforme (EM), Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN, Lyell’s syndrome), and drug reaction with eosinophilia and systemic symptoms (DRESS) are frequently associated with increased mortality. Neither their acute management nor their further allergy diagnostic testing to avoid re-exposure and enable restriction of substances prohibited due to the event are standardized. The management of severe adverse drug reactions was investigated in a 10-year monocentric retrospective study. TEN (43.5%) and EM (29.0%) were the two most common subtypes of severe adverse drug reactions, while AGEP (3.2%), SJS (6.5%), and DRESS (17.7%) were less frequent. The acute management of 62 patients with severe adverse drug reactions was generally performed using systemic glucocorticoids (58.1%) or as a combination therapy consisting of glucocorticoids and intravenous immunoglobulins (IVIG, 41.9%), which were usually used in severe clinical courses. The most commonly suspected triggers were beta-lactam antibiotics (28.8%), followed by metamizole (19.4%) and sulfonamide antibiotics (17.7%). Due to the rarity and heterogeneity of this patient population, there is scant reliable data on the systemic treatment of SJS/TEN. Therefore, whether it confers an evident benefit remains unclear. Although the allergy diagnostic testing of severe adverse drug reactions is complex, it is often able to yield important insights and should be performed.