Delayed Drug Reactions Research Articles

ORAL LICHENOID DRUG ERUPTION SECONDARY TO RITUXIMAB ADMINISTRATION

<h3>Introduction</h3> Oral lichenoid drug eruption (OLDR) is an uncommon type of fixed drug eruption (FDE) rarely described following administration of rituximab. This case illustrates the importance of developing a broad differential diagnosis, encompassing delayed drug reactions, in immunocompromised patients presenting with oral lesions. <h3>Case Description</h3> A 64-year-old male with a past medical history of marginal zone lymphoma presented with fixed oral lesions following rituximab monotherapy. Two weeks following his second rituximab dose, he developed painful oral ulcers. Infectious workup was negative. Systemic lupus erythematosus (SLE) was considered given positive anti-nuclear antibody, double-stranded DNA, and low complement levels, as was paraneoplastic pemphigus, but antibody screen was negative. Given concern for oral lymphoma, a biopsy was performed and showed reactive squamous mucosa with ulcerative mucositis without evidence of lymphoma. Morphologic features suggested rituximab-induced ulcerative lichenoid drug reaction. He was started on oral and topical corticosteroids for 2 weeks, and his symptoms fully resolved. He was advised to avoid rituximab. <h3>Discussion</h3> FDE has rarely been described with rituximab, even rarer still is OLDR. Biopsy of the oral lesions was needed to suggest an OLRD secondary to rituximab. FDE can occur up to 2 weeks following drug administration, aligning with this patient's time course. Classically, symptoms resolve within 7-10 days following drug discontinuation. Oral lesions can be more persistent and last for months. Treatment involves a combination of drug discontinuation, oral, topical, and intralesional corticosteroids, depending on severity. This case highlights the importance of considering delayed drug reaction in patients with oral ulcers.

Drug allergy: A 2022 practice parameter update

Drug allergy: A 2022 practice parameter update

Use of Rapid Drug Desensitization in Delayed Hypersensitivity Reactions to Chemotherapy and Monoclonal Antibodies.

Background:Rapid drug desensitization (RDD) allows first-line therapies in patients with immediate drug hypersensitivity reactions (DHR) to chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb). Desensitization in delayed drug reactions has traditionally used slow protocols extending up to several weeks; RDD protocols have been scarcely reported.Patients and Method:We retrospectively analyzed the patients referred to the Allergy Department, who had experienced a delayed DHR (> 6 h) related to a ChD or mAb and underwent an RDD protocol. The rate of successful administration of the offending drug and the presence of adverse reactions were evaluated.Results:A total of 93 RDDs were performed in 11 patients (including 6 men and 5 women, with a median age of 61 years). The primary DHR were maculopapular exanthema (MPE) (8), generalized delayed urticaria (1), MPE with pustulosis and facial edema (1), and facial edema with desquamative eczema (1). The meantime for the onset of symptoms was 3 days (range 1–16 days). RDD was performed using a protocol involving 8–13 steps, with temozolomide (25), bendamustine (4), rituximab (9), infliximab (24), gemcitabine (23), and docetaxel (8), within 4.6–6.5 h. Sixteen breakthrough reactions were reported during the RDD (17.2 %) in 5 patients; all were mild reactions including 11 delayed and 5 immediate reactions. All patients completed their treatment.Conclusions:RDD is a potentially safe and effective procedure in patients suffering from delayed reactions to ChD and mAb. It allows them to receive full treatment in a short period, thereby reducing time and hospital visits.

A case of vancomycin-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome with failure to respond to cyclosporine treatment

Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare delayed drug reaction that often occurs 2-6 weeks after initiation of therapy and may develop into a life-threatening systemic reaction. Besides immediate discontinuation of the suspected inciting drug, initiation of high dose systemic corticosteroids has long been the mainstay of treatment for severe cases. Nevertheless, significant drawbacks associated with systemic corticosteroid therapy, such as the requirement of a long tapering period post resolution and extensive adverse side effects profile, have motivated clinicians to seek alternative treatment options. Over the past decade, an undisputed increasing number of favorable case reports has highlighted cyclosporine as an emerging, safe, and effective alternative despite inconsistent dosing regimens reported. Herein, we report a severe case of vancomycin-induced DRESS syndrome in which the patient failed initial intervention with cyclosporine and needed rescue with methylprednisolone. To the best of our knowledge, this constitutes the first unsuccessful report of cyclosporine treatment for DRESS syndrome.

Diagnostic handling of the preparation of epicutaneous patch tests requested by the Allergology Department

BackgroundIn epicutaneous patch testing, the substance suspected of being responsible for the skin reaction (contact dermatitis and/or delayed drug reaction) is applied (in excipient) on the skin under occlusion to...

CD69 for in vitro diagnosis of delayed drug reactions

M. Yazicioglu, K. Cresswell, G. Whalen, J. N. Baraniuk; Georgetown University, Washington, DC. RATIONALE: CD69 is a rapidly up-regulated lymphoid activation antigen. We evaluated flow cytometric detection of CD69 on T cells for the diagnosis of delayed immune-mediated drug reactions. CASE REPORT: A 26 yr Caucasian non-Hispanic male had a 6 month history of facial and neck eczema. He used intranasal dihydroergotamine for 7 yr and oral finasteride for 1 89 yr. The rash responded to tacrolimus but not to stopping dihydroergotamine for 3 months. METHODS: Liquid dihydroergotamine, chloroform-extracted finasteride tablets, nickel sulfate, positive and negative controls were used for immediate and skin patch tests, and whole blood culture. TrueTest patch tests were also applied. Whole blood was diluted 1/5 with RPMI media, and cultured with dilutions of each substance. CD69+ subsets of CD3+, lymphocyte-gated CD4+ and CD8+ cells were counted by fluorescence assisted cell sorting (FACS) after 4 and 8 days. RESULTS: Puncture and intradermal tests were positive to histamine only. The nickel patch test was positive. Nickel and flnasteride significantly increased the Day 8/Day 4 ratios of CD69+CD8+ cells by 8-fold (p<0.001, X 2) and 4.9-fold (p<0.001), respectively. CD69+CD8+ responses were also significantly greater than the RPMI media negative control. There were no changes in CD4+ cells. CONCLUSIONS: Nickel sensitivity was detected by positive patch test and CD69+CD8+ responses. Finasteride was implicated as the cause of his eczema by the CD69+CD8+ proliferative response. These may represent drug-specific CD8+ cells. Funding: Self-funded