Drug-induced Reactions Research Articles

Patient Adherence to Written Instructions following Complete Allergological Evaluation for Suspected Beta-Lactam Allergy: A Tertiary Hospital Study in Greece.

Beta-lactam (BL) antibiotics are among the most prescribed groups of drugs worldwide and have been implicated in a variety of allergic reactions. There is a paucity of literature regarding patient adherence to prescribed instructions following comprehensive allergy assessments. The objective was to follow up the clinical course of BL allergy in patients who underwent thorough allergological investigation for suspected BL allergy at a tertiary hospital and ascertain patients' compliance with the provided written instructions. An observational study in patients referred for suspected BL allergy who underwent a comprehensive allergy workup (in vivo ± in vitro tests, DPT in culprit and/or alternative BL) and who subsequently received written instructions was conducted. Data on the nature of the reported drug hypersensitivity reaction, the culprit BL drug, the allergological workup, and the detailed instructions provided in a written drug allergy report were collected retrospectively. Patients' compliance with the instructions was recorded by a telephone survey using a pre-defined questionnaire. Among the 212 patients meeting the inclusion criteria, 87 patients (72.4% women; mean age 50.1 years; age range 6-84 years) responded to the telephone survey and were included in this study. Surprisingly, 45 out of 87 (51.7%) patients did not adhere to the written instructions. The primary factor contributing to non-compliance was the fear of re-occurrence of a drug-induced allergic reaction (personal and/or triggered by their treating physician reluctance), accounting for 77.7% of cases. The analysis demonstrated that the initial reaction's severity and type, as well as the outcomes of skin testing, did not correlate with compliance to instructions (p > 0.05). Surprisingly enough, a drug provocation test (DPT), irrespectively of the result, emerged as a negative predictor for adherence, with only 40.6% of DPT patients complying compared to 77.8% of those who did not undergo DPT (p = 0.005; odds ratio = 0.195; 95% confidence interval: 0.058-0.655). Variables such as performing DPT with alternative or incriminated drugs or the result of the DPT (positive-negative) were not associated with patient compliance. Conversely, the type of instructions provided exhibited a noteworthy correlation with compliance. Patients who were explicitly instructed to entirely avoid all BL antibiotics demonstrated markedly higher adherence rates (83.3%) compared to those who were advised to have a partial or complete release of BLs (31.8% and 58.1%, respectively; p < 0.05). Notably, among compliant patients who received either the original culprit drug or the alternative (32 out of 87, 36.7%), no allergic reactions were reported. In contrast, among the 12 patients with written avoidance of all BLs, subsequent BL intake led to immediate reactions (Grade I and IV) in 2 patients (16.6%). A notable disparity in patient adherence to written instructions prohibiting or releasing beta-lactams was demonstrated. Less than half of the patients ultimately complied with the provided instructions, underscoring the need for tailored patients' education and strategies to improve adherence in the management of suspected BL allergy.

Atypical Intralymphatic T-Cell Proliferation during DRESS Mimicking Intravascular Lymphoma: Case Report

Drug-induced hypersensitivity syndrome or drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug-induced reaction that represents a life-threatening condition. The histopathologic appearance of the skin biopsy is nonspecific but may exceptionally show an atypical intralymphatic lymphocytic infiltrate, and mimic an intravascular lymphoma. Through this article, we will report an exceptional case of a patient presenting with skin lesions pointing to a dress, but whose histological appearance, in the presence of adenopathy during physical examination, can lead, by mistake, to the diagnosis of an intralymphatic lymphoma. We aim to highlight the various diagnostic indices allowing the distinction between these two entities, including the immunohistochemical study, the search for the TcR clonal rearrangement and the anatomo-clinical correlation.

Dapsone induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, sparing leprosy patches as an ‘anatopic’ response: A case report

Dapsone induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, sparing leprosy patches as an ‘anatopic’ response: A case report

Characteristics of adverse drug reactions due to nonsteroidal anti-inflammatory drugs: a cross-sectional study.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for treating pain and inflammation. Spontaneous adverse drug reaction (ADR) reports represent a rich data source for the detection of unknown and rare ADRs. This cross-sectional study aimed to analyze the characteristics of ADRs due to NSAIDs in Thailand. All ADR reports of NSAIDs for systemic use from 2015 to 2019 were extracted from the national database in Thailand. Patient characteristics, drug use information, adverse event information, and source of senders in 32,857 reports were analyzed. The annual number of ADR reports due to NSAIDs decreased from 7,008 in 2015 to 5,922 in 2019. The most frequently reported drug was ibuprofen (n=12,645, 38.5%) followed by diclofenac (n=7,795, 23.7%), most patients were 40-59 years old, and the major adverse reaction was angioedema (n=7,513, 22.9%). Serious reactions were recorded in 20.7% (n=6,801) of the total ADRs. Most patients (n=20,593, 62.7%) recovered without sequelae, but there were 5,420 patients (16.5%) who could not recover and 3,109 patients (9.5%) who were recovering. Eight patients (0.02%) died of Stevens-Johnson syndrome (n=3), toxic epidermal necrolysis (n=4), and anaphylactic shock (n=1), which were possibly related to ADRs. The number of ADR reports due to NSAIDs decreased from 2015 to 2019 in Thailand. Serious ADRs and death cases accounted for 20.7% and 0.02%, respectively. Most fatal cases exhibited severe drug-induced skin reactions.

Drug-induced cardiac toxicity and adverse drug reactions, a narrative review

Drug-induced cardiotoxicity is a primary concern in both drug development and clinical practice. Although the heart is not a common target for adverse drug reactions, some drugs still cause various adverse cardiac events, with sometimes severe consequences. Direct cardiac toxicity encompasses functional and structural changes of the cardiovascular system due to possible exposure to medicines. This phenomenon extends beyond cardiovascular drugs to include non-cardiovascular drugs including anticancer drugs such as tyrosine kinase inhibitors, anthracyclines and immune checkpoint inhibitors (ICIs), as well as various antipsychotics, venlafaxine, and even some antibiotics (such as macrolides). Cardiac ADRs comprise an array of effects, ranging from heart failure and myocardial ischemia to valvular disease, thrombosis, myocarditis, pericarditis, arrhythmias, and conduction abnormalities. The underlying mechanisms may include disturbances of ionic processes, induction of cellular damage via impaired mitochondrial function, and even hypercoagulability. To mitigate the impact of drug-induced cardiotoxicity, multi-stage evaluation guidelines have been established, following the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines for in vitro and in vivo testing. Despite preclinical safeguards, post-marketing surveillance remains critical, as certain cardiotoxic drugs may escape initial scrutiny. Indeed, historical data show that cardiovascular ADRs contribute to almost 10% of market withdrawals. The impact of drug-induced cardiotoxicity on cardiac issues, particularly heart failure, is often underestimated, with incidence rates ranging from 11.0% to over 20.0%. We here comprehensively examine different patterns of drug-induced cardiotoxicity, highlighting current concerns and emerging pharmacovigilance signals. Understanding the underlying mechanisms and the associated risk factors is critical in order to promptly identify, effectively manage, and proactively prevent drug-induced cardiac adverse events. Collaborative efforts between physicians and cardiologists, coupled with thorough assessment and close monitoring, are essential to ensuring patient safety in the face of potential drug-induced cardiotoxicity.

Dual effect of tacrolimus on mast cell–mediated allergy and inflammation through Mas-related G protein-coupled receptor X2

BackgroundTopical tacrolimus, although widely used in the treatment of dermatoses, presents with an immediate irritation on initial application resembling a pseudo-allergic reaction. Mas-related G protein-coupled receptor X2 (MRGPRX2) in mast cells (MCs) mediates drug-induced pseudo-allergic reaction and immunoglobulin E (IgE)-independent pruritis in chronic skin diseases. However, the immunosuppression mechanism of tacrolimus on MCs via MRGPRX2 has not been reported. ObjectiveTo investigate the role of MRGPRX2 and the mechanism of action of tacrolimus on its short-term and long-term applications. MethodsWild-type mice, KitW-sh/W-sh mice, and MrgprB2-deficient (MUT) mice were used to study the effect of tacrolimus on in vivo anaphylaxis model. LAD2 cells and MRGPRX2-knockdown LAD2 cells were specifically used to derive the associated mechanism of the tacrolimus effect. ResultsShort-term application of tacrolimus triggers IgE-independent activation of MCs via MRGPRX2/B2 in both in vivo and in vitro experiments. Tacrolimus binds to MRGPRX2, which was verified by fluorescently labeled tacrolimus in cells. On long-term treatment with tacrolimus, the initial allergic reaction fades away corresponding with the downregulation of MRGPRX2, which leads to decreased release of inflammatory cytokines (P < 0.05 to P < 0.001). ConclusionShort-term treatment with tacrolimus induces pseudo-allergic reaction via MRGPRX2/B2 in MCs, whereas long-term treatment downregulates expression of MRGPRX2/B2, which may contribute to its potent immunosuppressive effect in the treatment of various skin diseases.

Case series of a varied spectrum of drug reactions

Adverse drug reactions are an important cause of iatrogenic morbidity and mortality in the medical field across the globe. As newer drugs emerge into the market, newer adverse reactions are being reported. More than half of these new drugs have serious side effects. A distinction between numerous patterns of drug-induced reactions is potentially of critical importance because a delay even of several hours may make the difference between survival and death. Herein, we report five cases of severe cutaneous adverse drug reactions admitted at our dermatology ward. Key words: Adverse drug reaction, Iatrogenic morbidity

A scoping review of literature on clozapine from former USSR states published in Russian language

ObjectiveAccess to literature on clozapine in Russian language remains strikingly limited. We aimed to identify and translate clinical evidence on clozapine-based treatment outcomes. MethodsWe performed a systematic review in PubMed, Embase and scientific indexes from former USSR states searching for articles published in Russian from the database inception till January 2023 and summarized the data in a scoping review (PROSPERO Reg. Number CRD42023386737). ResultsA total of 60 papers were included comprising eight main topic categories: 1) clozapine-related intoxications (n = 20), 2) effectiveness/efficacy and safety of clozapine treatment (n = 14), 3) adverse drug-induced reactions (ADRs) related to clozapine treatment (n = 9), 4) therapeutic drug monitoring for clozapine (n = 5), 5) combination of clozapine and non-pharmacological treatments (n = 4), 6) pharmacoepidemiology of clozapine (n = 3), 7) effects of clozapine on the brain electrical activity (n = 3), and 8) novel clozapine formulations (n = 2). Among clozapine-related intoxications there were reports of criminal poisoning, which was associated with low lethality. Worse outcomes were accompanied by systemic reactions to intoxications. Clinical benefits of hemoadsorption were reported in the management of clozapine-related intoxications. Only half of studies reporting clozapine effectiveness used standardized scales to assess outcomes. Clozapine superiority in treatment-resistant schizophrenia (TRS) was replicated in one trial. No reports of clozapine-related agranulocytosis were identified. Clozapine ranked among most prescribed antipsychotics for TRS and non-TRS. ConclusionsAs clinical research in former USSR states is advancing to adopt western clinical research standards, comparability and extrapolation of findings is expected to increase, with transfer of older findings to clinical practice being particularly challenging.

Bullous Pemphigoid Associated with Aspirin Drug Reaction: A Case Report

&lt;p&gt;一位有橫斷性脊髓炎病史規律服用免疫抑制劑移護寧(azathioprine)的64歲男性，因心房顫動以阿斯匹靈(aspirin)治療約一年，來到門診主訴軀幹和大腿出現散佈性紅疹和水泡，經診所開立的抗生素和抗病毒藥物治療未改善，以蜂窩性組織炎診斷收治住院，隨後皮膚切片檢查證實為類天皰瘡，經評估停用阿斯匹靈並以靜脈注射類固醇治療，症狀好轉後出院，並持續接受門診追蹤。類天皰瘡為好發於70歲以上老年人的自體免疫疾病，隨著人口老化、多重共病以及可能引發此疾病的藥物增加，類天皰瘡的發病率在過去幾十年中有所增加，阿斯匹靈在病理機轉上也被指出可能引發類天皰瘡，雖然目前的系統性回顧顯示兩者之間並沒有顯著相關，但有鑒於新藥開發，藥物誘發性皮膚反應增多，若發現病人皮膚出現水泡，合併發燒、喘、低血壓、皮膚疼痛、大面積脫皮或成灰紫色，侵犯眼睛、咽喉或消化道黏膜等應立即停用可能誘發此皮膚表現的藥物，並轉介專科醫師。類天皰瘡的治療以類固醇和免疫抑制劑為主，長期使用可能增加高血壓、糖尿病、骨質疏鬆與感染等風險，病人於後續門診追蹤，基層醫師評估皮膚病灶改善狀況，以每2-3週的頻率減低藥物劑量，並根據病人的年齡和狀況安排藥物相關副作用的檢查。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;A 64-year-old male with a history of transverse myelitis and regular use of immunosuppressive agent azathioprine presented to our outpatient clinic with a complaint of disseminated erythematous rash and blisters on the trunk and thighs. He had been treated with aspirin for atrial fibrillation for about a year. Despite treatment with antibiotics and antiviral medications prescribed by the clinic, the symptoms did not improve, and he was admitted to the hospital with a diagnosis of cellulitis. Subsequent skin biopsy confirmed the diagnosis of bullous pemphigoid. After further assessments, aspirin was discontinued, and intravenous corticosteroid therapy was initiated, leading to symptom improvement. The patient was later discharged for follow-up in the outpatient clinic. Bullous pemphigoid is an autoimmune disease that predominantly affects elderly individuals aged 70 and above. Due to multiple comorbidities and increased use of medications that may trigger this disease, the incidence of bullous pemphigoid has been on the rise in recent decades among the elderly population. Aspirin has been suggested to be a potential trigger for bullous pemphigoid in its pathophysiology. Although current systematic reviews do not show a significant association between the two, the increased development of drug-induced skin reactions with the advent of new medications warrants caution. If a patient develops blisters on the skin, along with fever, wheezing, hypotension, skin pain, extensive peeling, or a grayish-purple discoloration, or if the condition affects the eyes, throat, or gastrointestinal mucosa, the medication potentially causing this skin manifestation should be discontinued immediately, and the patient should be referred to a specialist. &lt;/p&gt; &lt;p&gt; The treatment of bullous pemphigoid primarily involves steroids and immunosuppressive agents. Long-term use of these medications may increase the risk of side effects such as hypertension, diabetes, osteoporosis, and infections. After patients return to outpatient follow-up, primary care physicians should carefully assess whether the skin lesions have improved. Medication dosage should be gradually reduced with a frequency of every 2-3 weeks, and examinations for medication-related side effects should be arranged based on the patient’s age and condition.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Stevens-johnson Syndrome and Toxic Epidermal Necrolysis: An Overview of Diagnosis, Therapy Options and Prognosis of Patients.

Both Stevens-johnson syndrome (SJS) and Toxic-epidermal necrolysis (TEN) are generally medication-induced pathological conditions that mostly affect the epidermis and mucus membranes. Nearly 1 to 2 patients per 1,000,000 population are affected annually with SJS and TEN, and sometimes these maladies can cause serious life-threatening events. The reported death rates for SJS range from 1 to 5%, and 25 to 35% for TEN. The mortality risk may even be higher among elderly patients, especially in those who are affected by a significant amount of epidermal detachment. More than 50% of TEN patients who survive the illness may experience long-term lower quality of life and lesser life expectancy. The clinical and histopathological conditions of SJS and TEN are characterized by mucocutaneous discomfort, haemorrhagic erosions, erythema, and occasionally severe epidermal separation that can turn into ulcerative patches and dermal necrosis. The relative difference between SJS and TEN is the degree of ulcerative skin detachment, making them two extremes of a spectrum of severe cutaneous adverse drug-induced reactions (cADRs). In the majority of cases, serious drug-related hypercreativities are considered the main cause of SJS & TEN; however, herpes simplex virus and Mycoplasma pneumoniae infections may also produce similar type clinical conditions. The aetiology of a lesser number of cases and their underlying causative factors remain unknown. Among the drugs with a 'greater likelihood' of causing TEN & SJS are carbamazepine (CBZ), trimethoprim-sulfamethoxazole, phenytoin, aminopenicillins, allopurinol, cephalosporins, sulphonamides, antibiotics, quinolones, phenobarbital, and NSAIDs of the oxicam variety. There is also a strong genetic link between the occurrence of SJS and IEN in the Han Chinese population. Such genetic association is based on the human leukocyte antigen (HLA-B*1502) and the co-administration of carbamazepine. The diagnosis of SJS is made mostly on the gross observations of clinical symptoms, and confirmed by the histopathological examination of dermal biopsies of the patients. The differential diagnoses consist of the exclusion of Pemphigus vulgaris, bullous pemphigoid, linear IgA dermatosis, paraneoplastic pemphigus, disseminated fixed bullous drug eruption, acute generalized exanthematous pustulosis (AGEP), and staphylococcal scalded skin syndrome (SSSS). The management of SJS & TEN is rather difficult and complicated, and there is sometimes a high risk of mortality in seriously inflicted patients. Urgent medical attention is needed for early diagnosis, estimation of the SCORTEN prognosis, identification and discontinuation of the causative agent as well as highdose injectable Ig therapeutic interventions along with specialized supportive care. Historical aspects, aetiology, mechanisms, and incidences of SJS and TEN are discussed. An update on the genetic occurrence of these medication-related hypersensitive ailments as well as different therapy options and management of patients is also provided.

Indirect and Direct 65+ Patient Reporting of Non-Steroidal Anti-Inflammatory Drug-Induced Adverse Drug Reactions as a Source of Information on Polypharmacy and Polypharmacy-Related Risk.

Background and Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs), which have anti-inflammatory and analgesic properties, are commonly used in the treatment of various, particularly frequent, as well as chronic, conditions in older patients. Due to common polypragmasia in these patients and a high risk of adverse drug reactions (ADRs) and drug interactions, pain management poses a therapeutic challenge. This study describes the importance of ADR reports in the identification of polypharmacy and the ensuing interactions. Materials and Methods: Both healthcare professionals (HPs) and non-healthcare professionals (non-HPs) reports collected in the EudraVigilance database of NSAIDs, including most commonly co-reported medications and reported reactions, were analysed and differences between HPs and non-HPs reports were identified. Results: In the analysed period and group, non-HPs reported more reactions but indicated fewer drugs as suspect or concomitant. The outcomes of our analysis indicate more HP engagement and more detailed reports of serious ADRs when compared to non-serious individual case safety reports (ICSRs) by non-HPs, which appeared more detailed. Such reactions as kidney failure and increased risk of bleeding are known adverse reactions to NSAIDs and common symptoms of their interactions, which were described in the available literature. They were much more frequently reported by HPs than by non-HPs. Non-HPs more frequently reported reactions that may have been considered less significant by HPs. Conclusions: The differences between healthcare professionals' (HPs) and non-healthcare professionals' (non-HPs) reports may result from the fact that the reports from patients and their caregivers require a professional medical diagnosis based on symptoms described by the patient or additional diagnostic tests. This means that when appropriately classified, medically verified, and statistically analysed, the data may provide new evidence for the risks of medication use or drug interactions.

Ulcerative colitis and pyoderma gangrenosum presentation of a case and brief literature review

Inflammatory bowel disease (IBD) is a chronic immune-mediated disorder comprised of Crohn's disease and ulcerative colitis. Ulcerative colitis affects the large intestine, while Crohn's disease can affect any part of the gastrointestinal tract (GIT). IBD is a multisystem condition that predominantly affects the gastrointestinal, musculoskeletal, ocular, and cutaneous systems. The following dermatological manifestations associated with IBDs have been identified: Specific manifestations with the same histological features of the underlying only ocurrs in Crohn Disease (CD); cutaneous disorders associated with IBD aphthous stomatitis, erythema nodosum; reactive mucocutaneous manifestations of IBDs pyoderma gangrenosum, Sweet’s syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis y mucocutaneous conditions secondary to treatment including injection site reactions y eczema and manifestations due to nutritional malabsorption such as stomatitis, glossitis, angular cheilitis hair and nail abnormalities. We believe dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance, such as psoriasiform eruption. One of the cutaneous manifestations associated with UC is pyoderma gangrenosum (PG), which is an inflammatory neutrophilic dermatosis that clinically presents with well-defined ulcers with an erythematous border and mucopurulent or hemorrhagic exudate.We present the case of a 44-year-old female patient, who presented non-specific chronic ulcerative colitis (UC) with active intestinal symptoms, fever, diarrhea and hematochezia, 20 days later it began with pustules on the head, trunk and extremities, which evolved into an ulcer with a border erythematous and well defined whose clinical and histopathological diagnosis corresponded to pyoderma gangrenosum.

Causes of Drug-Induced Severe Cutaneous Adverse Reaction Epidermal Necrolysis (EN): An Analysis Using FDA Adverse Event Reporting System (FAERS) Database.

The purpose of the study is to analyze FAERS data to identify drugs associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), determine demographics, drug classes involved, most likely resulted in death, and highlight emerging trends in SJS/TEN reactions. We reviewed the publicly available FAERS database from 2004-2021. Using search terms "Stevens-Johnson syndrome" or "Toxic epidermal necrolysis", we identified the reports of SJS/TEN or SJS/TEN followed by death that might associated with specific drugs. Then the amounts and trends were counted analyzed. During the study period of 2004-2021, the Food and Drug Administration (FDA) received a total of 14,363,139 reports of adverse reactions, among which 24,976 were linked to SJS or TEN. After excluding the cases with incomplete or insufficient information on age, gender, or country of origin, the median median age of patients was 53.82 (IQR = 57.52), the females accounted for 56.59% (12,827 cases) and 8,507 (38.34%) originated in the United States. The top 50 drugs were associated with 15,149 cases (60.65%). The subsequent fatal outcome occurring in 4878 out of 24,976 cases (19.53%). Top 3 drug classes associated with SJS/TEN in FAERS were antiepileptics, non-steroidal anti-inflammatory drugs (NSAIDs) and others. Top drug classes associated with SJS/TEN deaths were antineoplastic agents and cephalosporins. Linear regression showed that the annual percentage of monoclonal antibody-related SJS/TEN reactions increased at an average rate of 0.25% (95% confidence interval: 0.18, 0.32) from 0.00% in 2004 to 4.79% in 2021, faster than any other drug class except antigout drug (allopurinol). By using the publicly available FAERS data, we have identified some important themes and trends in drug-related SJS/TEN reactions. Monoclonal antibodies and proton pump inhibitors are drugs with emerging trends causing SJS/TEN. Additionally, cephalosporin antibiotics have a higher mortality rate following SJS/TEN.

Drug-induced pseudoallergy reaction through mas-related G-protein-coupled receptor X2: A narrative review

Drug-induced pseudoallergy reaction through mas-related G-protein-coupled receptor X2: A narrative review

Lamotrigine Induced Drug Reaction with Eosinophilia and Systemic Symptoms (Dress) Syndrome, Dysphagia and Steroid Pulse Therapy. A Case Report

Lamotrigine Induced Drug Reaction with Eosinophilia and Systemic Symptoms (Dress) Syndrome, Dysphagia and Steroid Pulse Therapy. A Case Report

Inflammatory and Infectious Disorders in Endocrine Pathology.

A variety of inflammatory conditions may directly involve the endocrine glands, leading to endocrine dysfunction that can cause severe consequences on patients' health, if left untreated. Inflammation of the endocrine system may be caused by either infectious agents or other mechanisms, including autoimmune and other immune-mediated processes. Not infrequently, inflammatory and infectious diseases may appear as tumor-like lesions of endocrine organs and simulate neoplastic processes. These diseases may be clinically under-recognized and not infrequently the diagnosis is suggested on pathological samples. Thus, the pathologist should be aware of the basic principles of their pathogenesis, as well as of their morphological features, clinicopathological correlates, and differential diagnosis. Interestingly, several systemic inflammatory conditions show a peculiar tropism to the endocrine system as a whole. In turn, organ-specific inflammatory disorders are observed in endocrine glands. This review will focus on the morphological aspects and clinicopathological features of infectious diseases, autoimmune disorders, drug-induced inflammatory reactions, IgG4-related disease, and other inflammatory disorders involving the endocrine system. A mixed entity-based and organ-based approach will be used, with the aim to provide the practicing pathologist with a comprehensive and practical guide to the diagnosis of infectious and inflammatory disorders of the endocrine system.

When Common Medications Trigger a Rare Reaction: A Review of Clinical Features, Diagnosis, and Treatment Options of DRESS Syndrome

Introduction and purpose: Drug-induced reaction with eosinophilia and systemic symptoms (DRESS) is a severe, life-threatening systemic drug reaction. The challenges in identifying DRESS syndrome result from its symptoms being variable, diverse, and unspecific. Due to the potentially lethal consequence, any clinician should be aware of the symptomatology and be prepared to initiate the appropriate steps. This review summarizes the clinical manifestations and provides essential information on the management of the illness. State of knowledge: DRESS appears to be a rare reaction that frequently remains undetected due to its atypical clinical presentation. Fever, skin rash, lymphadenopathy, eosinophilia, and organ involvement as well as other manifestations, may occur. The onset may be delayed by weeks after exposure to the offending drug. DRESS syndrome is classified as a type IV hypersensitivity. It is thought to be triggered by antiepileptic drugs and antibiotics although many other medications can cause the condition. Certain genetic factors may also predispose some individuals to develop DRESS. Combining clinical and laboratory findings can help confirm the diagnosis. Discontinuation of the offending drug is the fundamental component of treatment such as supportive care including the use of antihistamines and corticosteroids, but recent research has discovered additional promising therapy options. Conclusions: Detecting DRESS syndrome early is crucial to ensure prompt treatment, prevent serious complications, and improve patient outcomes. Healthcare providers should be aware of the signs and symptoms of DRESS syndrome, especially in patients taking particular medications, and be prepared to investigate further if it is suspected.

Knowledge, attitudes, and practices regarding drug allergy among healthcare providers in Eastern India

Background: Drug allergy (DA) or hypersensitivity is an immunologically mediated reaction producing stereotype symptoms which is challenging for health care providers (HCP). Objective of current study was to assess the knowledge, attitudes and practices of drug allergy among healthcare providers in eastern India. Methods: A 25-item self-administered DA questionnaire was developed and applied in our study. The questionnaire covered 3 domains: knowledge, attitudes, and practice patterns. From July 2020 to September 2020, HCPs participated in the cross-sectional study. Results: A total of 237 HCPs participated in the study, and all questionnaires were analysed. Among the respondents, 226 (95.4%) were nurses, 9 (3.8%) were doctors and 2 (0.8%) were pharmacists. The majority of HCPs agreed that drug-induced immediate allergic reactions were IgE mediated 225 (94.9%), occur within 6 hours of drug administration (89.9%), and epinephrine was the first choice for drug-induced anaphylaxis (76.8%). 97.9% HCPs agreed that penicillin skin test was valuable to predict the allergic reaction. More than 80% of the respondents would take patients’ allergic history before drug administration, while 75.5% agreed that they recognize and manage drug allergy timely when it occurs. Conclusions: Drug allergy was often diagnosed and managed inadequately, regardless of practice location, employment status and speciality in eastern India. The HCPs demonstrated a low level of knowledge regarding DA. Advanced education is urgently needed for better understanding and filling the gaps that exist in the knowledge and clinical practice of DA.

Urticaria: A Narrative Overview of Differential Diagnosis.

Urticaria is an inflammatory skin disorder that may occur in isolation or associated with angioedema and/or anaphylaxis. Clinically, it is characterized by the presence of smooth, erythematous or blanching, itchy swelling, called wheals or hives, which greatly vary in size and shape and last less than 24 h before fading to leave normal skin. Urticaria is the consequence of mast-cell degranulation that can be caused by immunological or non-immunological mechanisms. From a clinical point of view, many skin conditions can mimic urticaria and their recognition is mandatory for a correct management and therapeutic approach. We have reviewed all of the main relevant studies which addressed differential diagnosis of urticarial, published until December 2022. The National Library of Medicine PubMed database was used for the electronic research. The present review offers a clinical narrative overview, based on the available literature, of the principal skin disorders that can be misdiagnosed as urticaria (mainly autoinflammatory or autoimmune disorders, drug-induced reactions, and hyperproliferative diseases). The aim of this review is to provide clinicians a useful tool for correctly suspecting and identifying all of these conditions.

Drug-induced oral lichenoid reactions in patients consuming antihypertensive drugs

Objectives: High blood pressure (HBP) is a persistent and widespread condition, and increasing numbers of patients are taking medication to reduce HBP symptoms and control blood pressure. Patients taking specific antihypertensive medications have been reported to experience oral lichenoid reactions. Various antihypertensive drugs have entered the market, and it is essential to study how they may affect the occurrence of oral lichenoid reactions. This study aimed at assessing the frequency of drug-induced oral lichenoid responses in patients receiving antihypertensive medications.&#x0D; Methods: Four hundred fifty patients who took hypertension medications referring to Seyed al-Shohdai Hospital in Urmia in 2021 were the subject of this cross-sectional study. After the patient's first visit to the hospital, a thorough medical history was obtained from them. The type, dose, and duration of antihypertensive medications taken at the study's time were questioned and documented together with demographic data. The diagnosis of the oral lichenoid reactions was then made by examining the patients. Chi-square and Spearman's correlation tests were used in SPSS version 26 to evaluate the data.&#x0D; Results: Oral lichenoid reaction was observed in about 3.3% of patients. The average age of patients who showed oral lichenoid reaction was 53.7 ± 7.1, they had taken medicine for an average of 1 to 30 months, and 66.7% were female.&#x0D; Conclusions: Patients taking antihypertensive drugs, e.g., hydrochlorothiazide, methyldopa, metoprolol, and propranolol, should be examined and followed up regarding oral lichenoid reactions.