Cutaneous adverse reactions to calcium channel blockers.

BACKGROUND: Previous studies have shown that calcium channel blockers can cause cutaneous adverse reactions; however, the amounts of data collected are limited. Recently, there have been new drugs available for which only a few reports have been published with regard to cutaneous adverse reactions. OBJECTIVE: The purpose of our study was to estimate the rate and to study clinical patterns of cutaneous adverse drug reactions to calcium channel blockers. METHODS: Medical records of patients who had cutaneous adverse reactions to calcium channel blockers between January 2004 and December 2010, at the Adverse Drug Reaction Center of Siriraj hospital, Mahidol University, Bangkok, Thailand were reviewed. RESULTS: From 996,583 prescriptions of calcium channel blockers, forty six patients developed cutaneous adverse effects. Diltiazem was the drug that showed the highest rate of cutaneous reactions per million prescriptions. Maculopapular rash was the most common dermatologic manifestation (41.7%), followed by ankle/pedal edema (18.8%). Three patients (6.2%) developed Stevens-Johnson syndrome due to amlodipine and 1 patient (2.1%) developed toxic epidermal necrolysis due to manidipine. Four patients (8.7%) had renal or cardiovascular involvement. CONCLUSIONS: It is important to keep in mind that some patients may develop cutaneous adverse reactions, including severe reactions, from calcium channel blockers.

Cutaneous adverse drug reactions in the elderly: a retrospective analysis in Thailand.

BACKGROUND: Elderly people tend to be sicker than young people. They also take more medications, increasing the risk of adverse drug reactions (ADRs), which are one of the leading causes of morbidity and mortality in this age group. Knowledge of cutaneous ADRs from medicine use in the elderly population is limited. OBJECTIVE: The aim of this study was to investigate demographic data, causative drugs and cutaneous manifestations of ADRs in elderly patients. METHODS: A retrospective analysis was conducted involving elderly patients aged >60 years with cutaneous ADRs in the period from 2002 to 2012. We analyzed data with respect to demographic data, clinical data, outcomes, and risk factors for serious reactions. RESULTS: A total of 400 patient records were included. The mean age was 73.6 years, and 53 % were women. The common reactions were maculopapular rash (65 %) and angioedema with/without urticaria (11.3 %). Antibiotics (42.8 %) and non-steroidal anti-inflammatory drugs (9.5 %) were common causative drugs. Serious cutaneous ADRs were found in 16.5 %. CONCLUSION: Our results show that multiple underlying medical conditions, especially cerebrovascular diseases, are risk factors for serious cutaneous ADRs in elderly patients. These findings emphasize the need for awareness about cutaneous drug reactions in elderly patients.

Adverse reactions to iodinated contrast media: prevalence, risk factors and outcome-the results of a 3-year period.

BACKGROUND: Iodinated contrast media (CM) are commonly used. Hypersensitivity reactions to CM occasionally result in morbidity. Risk factors and the role of premedication remain to be investigated. OBJECTIVE: We sought to explore the prevalence, risk factors and outcome of CM reactions. METHODS: The retrospective case-control study was conducted between 2008 and 2010. In total, 55,286 subjects who were exposed to iodinated CM were enrolled to determine the prevalence of CM reactions. The case-control statistical method was applied to determine the risk factors of CM reactions. 579 subjects who had CM reactions were categorised in the case group and 1,175 of the 55,286 subjects who had tolerated CM exposure were randomised for the control group. RESULTS: The overall prevalence of CM reactions was 1.05%. In a multivariate analysis, the history of previous CM reactions, female gender and the history of seafood allergy were significant risk factors for CM reactions. The significant risk factors for the first episode of CM reactions were female gender, the history of seafood allergy and asthma. We found sixteen serious reactions in the immediate reaction group: ten fully recovered after hospitalisation, five fully recovered after out-patient treatment and one died after the administration of CM via an intra-arterial route during coronary angiogram. The most significant risk factor associated with serious reactions was asthma, whereas comorbid cardiovascular disease, male gender, history of seafood allergy and history of previous CM reactions were significant risk factors for mild reactions. CONCLUSIONS: The prevalence of CM adverse reactions was as low as 1.05%. Risk factors consist of a history of previous CM reactions, female gender and seafood allergy. Nevertheless, serious immediate reactions could occur particularly in patients with asthma.

Cutaneous reactions to proton pump inhibitors: a case-control study.

BACKGROUND: Even though proton pump inhibitors (PPIs) are commonly used in clinical practice, a limited number of studies are available about cutaneous adverse reactions from PPIs, and most of these are case reports. OBJECTIVE: To demonstrate the pattern of cutaneous reactions related to PPI usage and to evaluate the risk of developing PPI drug eruptions among adult patients. METHODS: We reviewed the spontaneous reports of any adverse events associated with PPI use, as reported from January 2005 through May 2010 to the Adverse Drug Reaction Center at Siriraj Hospital in Thailand. Each control was sampled from 15 patients who had consecutive hospital numbers from each study case. RESULTS: The prevalence of cutaneous reactions to PPIs varied, ranging from three to 20 per 100,000 of the treated population. Sixty-four patients with a history of reaction to PPIs, and 65 controls were enrolled. Most cutaneous reactions were attributed to omeprazole (n=50; 78.1%), and the most frequently observed cutaneous reaction was maculopapular rash (43.8%). None of the patients experienced a cross-reaction between individual PPIs. CONCLUSION: Cutaneous adverse reactions to PPIs range from minor drug rashes to a severe, life-threatening reaction. Individuals with a history of adverse drug reaction have an increased risk of cutaneous reaction to PPIs.

Drug-induced urticaria: causes and clinical courses.

The authors retrospectively reviewed medical records of patients who were diagnosed as having drug-induced urticaria at Siriraj Hospital of Mahidol University (Bangkok, Thailand) between October 2004 and April 2007. One hundred and forty-seven drugs were presumed as causing acute urticaria. Females were affected more commonly than males. The most frequent drug groups were antibiotics, followed by non-steroidal anti-inflammatory drugs (NSAIDs). The most common culprit drugs were ceftriaxone, cephalexin, amoxicillin and diclofenac, respectively. The median duration of onset and of clinical remission were 18 hours and 24 hours, respectively. Antibiotics were the most frequent causes of drug-induced urticaria, of which cephalosporins were the most common causative drugs. Oral NSAIDs significantly had the shortest median onset of urticaria. After discontinuing the culprit drugs, the reactions usually disappeared within a few days.

Cutaneous adverse reactions to sulfonamide antibiotics.

BACKGROUND: Sulfonamides are divided into two main groups which are sulfonamide antibiotics and sulfonamide non-antibiotics. The wide use of sulfonamide antibiotics leads to increasing incidence of sulfonamide cutaneous reactions. OBJECTIVE: The purpose of this study is to explore the cutaneous manifestations induced by sulfonamide antibiotics in a large number of Thai patients, including human immunodeficiency virus (HIV) and non-HIV infected individuals. The second purpose is to determine the risk factors for development of sulfonamide cutaneous reactions. METHODS: We retrospectively studied 191 patients with sulfonamide antibiotics cutaneous reactions attending the adverse drug reaction center, Siriraj Hospital, Bangkok between 2006 and 2010. RESULTS: Majority of the patients was female (59.7%).Maculopapular rash was the most common cutaneous manifestation (37.7%) followed by fixed drug eruption (22%), angioedema with or without urticaria (12.6%) and urticaria alone (12%). Among those with known HIV serology, maculopapular eruption occurred more frequently in the HIV positive group while fixed drug eruption occurred more frequently in HIV-negative group. CONCLUSION: From our study, there were no significant determination factors to develop serious drug reactions. However, the HIV-positive status and lower level of CD4 count had a tendency to increase risk of developing serious cutaneous reactions.

Cutaneous reactions to non-steroidal anti-inflammatory drugs.

We retrospectively reviewed the records of 195 patients with suspected cutaneous reactions from NSAIDs. Two hundred and six different non-steroidal anti-inflammatory drugs (NSAIDs) were suspected of causing cutaneous reactions, and the most frequent suspected causative NSAID was ibuprofen (25.7%). Angioedema and/or urticaria were the most frequent cutaneous reactions (54.4%), and the foremost suspected causative drug for these reactions was ibuprofen. The second most frequently found cutaneous reaction was maculopapular eruption (26.2%), and celecoxib was the most commonly suspected causative NSAID for it. The primary suspected NSAIDs causing fixed drug eruption were in enolic acid group. Furthermore, drug hypersensitivity syndrome was diagnosed in five patients, and Stevens-Johnson syndrome and toxic epidermal necrolysis were detected in five patients.

Cutaneous adverse reactions to fluoroquinolones.

BACKGROUND: To date, even though there are some large studies on adverse reactions related to fluoroquinolones, there is no comprehensive study focusing on cutaneous adverse drug reactions associated with their use. OBJECTIVE: To demonstrate the pattern of cutaneous reaction related to the administration of each type of fluoroquinolone and to study the cross-sensitivity between various types of fluoroquinolones. METHODS: Voluntary reports of any adverse events associated with fluoroquinolone use as reported from January 2004 to December 2008 and obtained from the Adverse Drug Reaction Center, Siriraj Hospital, Thailand, were reviewed. RESULTS: Among 166,736 patients who had been treated with fluoroquinolones, the prevalences of adverse reaction and cutaneous adverse reaction were 0.13% and 0.09%, respectively. The prevalence of cutaneous reaction to individual fluoroquinolones varies between 0.04% and 0.37%. One hundred fifty-one subjects were enrolled. Most cutaneous reactions were attributed to ciprofloxacin (n = 93), and the most frequent adverse cutaneous reaction seen was maculopapular rash (39.7%). Thirteen cases (8.6%) involved a previous history of fluoroquinolone hypersensitivity; among these, 15.4% had cross-reactivity potential. CONCLUSION: These data suggest that individual fluoroquinolones are responsible for different types and frequencies of cutaneous reactions, with some potentiality of cross-reactivity between different generations.

The utility of the World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) system for the assessment of adverse drug reactions in hospitalized children.

Although the World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) system has been suggested as a practical tool for classifying adverse drug reactions (ADRs), verification of such system has not been examined. The objective of this study was to evaluate the usefulness of the WHO-UMC classification for the diagnosis of ADRs. The gold standard was the results of drug challenges and serum tryptase in cases of anaphylaxis. Twenty-seven children had ADRs classified by the WHO-UMC system. The causality terms were 'certain' in 4/27, 'probable' in 6/27, 'possible' in 10/27 and 'unlikely' in 7/27 of the patients. Skin prick tests and intradermal tests were positive in 1/20 and 1/5 of the patients, respectively. Drug challenges and serum tryptase were positive in 8/26 and 1/3 of the patients, respectively. After complete evaluation, the positive and negative ADRs were documented in 9/27 patients (33.33%) and 18/27 patients (66.67%), respectively. The multi-level likelihood ratios for ADRs using the WHO-UMC system were infinity in causality term 'certain', 2 in 'probable', 0.5 in 'possible', and 0 in 'unlikely'. In conclusion, causality term 'certain' and 'unlikely' of the WHO-UMC system had large impact on the likelihood of ADRs. In contrast, the causality term 'probable' and 'possible' had small impact on the likelihood of ADRs. Drug challenges and serum tryptase were helpful to confirm ADRs categorized by WHO-UMC system.

Angioedema: clinical and etiological aspects.

Angioedema is an abrupt swelling of the skin, mucous membrane, or both including respiratory and gastrointestinal tracts. This study aimed to report an experience of angioedema in a university hospital with respect to etiologies, clinical features, treatment, and outcome. One hundred and five patients were enrolled. About half had angioedema without urticaria. The common sites of involvement were periorbital area and lips. Forty five patients (49%) had systemic symptoms. The most common cause of angioedema was allergic angioedema. Nonsteroidal anti-inflammatory drug-induced angioedema and idiopathic angioedema were detected in 20% and 18%, respectively. Among patients with allergic angioedema, 41.7% were caused by food, 39.6% by drugs. Thirty seven patients (39%) had recurrent attacks of angioedema. Mean standard deviation (SD) number of attacks in patients with recurrent angioedema was 3.9 (2.7) (ranging from 2 to 10 times). Patients who had older age and multiple sites of skin involvement had tendency to have systemic symptoms.