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January 1990, Vol 126, No. 1 >
Article | January 1990

Diagnosing Cutaneous Adverse Reactions to Drugs

Neil H. Shear, MD
[+] Author Affiliations

Dermatology A# Sunnybrook Medical Center 2075 Bayview Ave Toronto, Ontario Canada M4N 3M5


Arch Dermatol. 1990;126(1):94-97. doi:10.1001/archderm.1990.01670250100017
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Comments

Erythema multiforme (EM) develops in a patient on the 10th day of therapy with sulfamethoxazole and trimethoprim. The therapy was initiated for the treatment of an upper respiratory tract infection. The drug treatment was stopped and the patient's condition improved over the subsequent week. For a dermatologist, the above scenario is all too familiar. I will build on this sample clinical problem in the following review; but first, what is the challenge? Ask yourself the following question (as I am sure the patient and referring physician will): Did the drug cause this patient's skin problem? Before we move on, we must establish some facts about the case: let us assume the patient is a 12-year-old boy (if the patient were an adult, would that change your opinions?), the diagnosis is EM without a doubt, and there are no other complicating factors hidden from us. Your opinion could be a clear

REFERENCES

1 +
Lane D, Kramer M, Hutcheon T, Jones J, Naranjo C.  The causality assessment of adverse drug reactions using a Bayesian approach . Pharmaceut Med. 1987;;2:265-283.
2 +
Halevy S, Grunwald MH, Sandbank M, Buimovice B, Joshua H, Livni E.  Macrophage migration inhibition factor (MIF) in drug eruption . Arch Dermatol. 1990;;126:48-51.
3 +
Shear N.  Approach to adverse reactions to antimicrobial therapy in children . In: Koren G, Prober C, Gold R, eds. Antimicrobial Therapy in Children . New York, NY: Marcel Dekker Inc; 1984;:793-803.
4 +
Pere J, Begaud B, Haramburu F, Albin H.  Computerized comparison of six adverse drug reaction assessment procedures . Clin Pharmacol Ther. 1986;;40:451-461.
5 +
Louick C, Lacouture P, Mitchell A, et al.  A study of adverse reaction algorithms in a drug surveillance program . Clin Pharmacol Ther. 1985;;38:183-187.
6 +
Sackett D, Haynes R, Tugwell P.  Deciding whether your treatment has done harm . Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Mass: Little Brown & Co Inc; 1985;.
7 +
Girard M.  Conclusiveness of rechallenge in the interpretation of adverse drug reactions . Br J Clin Pharmacol. 1987;;23:73-79.
8 +
Kauppinen K.  Rational performance of drug challenge in cutaneous hypersensitivity . Semin Dermatol. 1983;;2:117-230.
9 +
Alanko K, Stubb S, Reitamo S.  Topical provocation of fixed drug eruption . Br J Dermatol. 1987;;116:561-567.
10 +
Bruynzeel D, van Ketel W.  Skin tests in the diagnosis of maculopapular drug eruptions . Semin Dermatol. 1987;;6:119-124.
11 +
Sox JHC, Blatt M, Higgins M, Marton K.  Understanding new information: Bayes' theorem . Medical Decision Making . Woburn, Mass: Butterworths; 1988;.
12 +
Shear N, Spielberg S.  Anticonvulsant hypersensitivity syndrome: in-vitro assessment of risk . J Clin Invest. 1989;;82:1826-1832.
13 +
Rieder M, Uetrecht J, Shear N, Cannon M, Miller M, Spielberg S.  Diagnosis of sulfonamide hypersensitivity reactions by invitro `rechallenge' with hydroxylamine metabolites . Ann Intern Med. 1989;;110:286-289.
14 +
Shear N, Spielberg S, Grant D, Tang B, Kalow W.  Differences in metabolism of sulfonamides predisposing to idiosyncratic toxicity . Ann Intern Med. 1986;;105:179-184.
15 +
Jones J, Herman R.  Special issue: the future of adverse drug reaction diagnosis: computers, clinical judgement and logic of uncertainty . Drug Inform J. 1986;;20:383-566.
16 +
Ghajar B, Lanctôt K, Shear N, Naranjo C.  Bayesian differential diagnosis of a cutaneous reaction associated with the administration of sulfonamides . Semin Dermatol. In press.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Lane D, Kramer M, Hutcheon T, Jones J, Naranjo C.  The causality assessment of adverse drug reactions using a Bayesian approach . Pharmaceut Med. 1987;;2:265-283.
2 +
Halevy S, Grunwald MH, Sandbank M, Buimovice B, Joshua H, Livni E.  Macrophage migration inhibition factor (MIF) in drug eruption . Arch Dermatol. 1990;;126:48-51.
3 +
Shear N.  Approach to adverse reactions to antimicrobial therapy in children . In: Koren G, Prober C, Gold R, eds. Antimicrobial Therapy in Children . New York, NY: Marcel Dekker Inc; 1984;:793-803.
4 +
Pere J, Begaud B, Haramburu F, Albin H.  Computerized comparison of six adverse drug reaction assessment procedures . Clin Pharmacol Ther. 1986;;40:451-461.
5 +
Louick C, Lacouture P, Mitchell A, et al.  A study of adverse reaction algorithms in a drug surveillance program . Clin Pharmacol Ther. 1985;;38:183-187.
6 +
Sackett D, Haynes R, Tugwell P.  Deciding whether your treatment has done harm . Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Mass: Little Brown & Co Inc; 1985;.
7 +
Girard M.  Conclusiveness of rechallenge in the interpretation of adverse drug reactions . Br J Clin Pharmacol. 1987;;23:73-79.
8 +
Kauppinen K.  Rational performance of drug challenge in cutaneous hypersensitivity . Semin Dermatol. 1983;;2:117-230.
9 +
Alanko K, Stubb S, Reitamo S.  Topical provocation of fixed drug eruption . Br J Dermatol. 1987;;116:561-567.
10 +
Bruynzeel D, van Ketel W.  Skin tests in the diagnosis of maculopapular drug eruptions . Semin Dermatol. 1987;;6:119-124.
11 +
Sox JHC, Blatt M, Higgins M, Marton K.  Understanding new information: Bayes' theorem . Medical Decision Making . Woburn, Mass: Butterworths; 1988;.
12 +
Shear N, Spielberg S.  Anticonvulsant hypersensitivity syndrome: in-vitro assessment of risk . J Clin Invest. 1989;;82:1826-1832.
13 +
Rieder M, Uetrecht J, Shear N, Cannon M, Miller M, Spielberg S.  Diagnosis of sulfonamide hypersensitivity reactions by invitro `rechallenge' with hydroxylamine metabolites . Ann Intern Med. 1989;;110:286-289.
14 +
Shear N, Spielberg S, Grant D, Tang B, Kalow W.  Differences in metabolism of sulfonamides predisposing to idiosyncratic toxicity . Ann Intern Med. 1986;;105:179-184.
15 +
Jones J, Herman R.  Special issue: the future of adverse drug reaction diagnosis: computers, clinical judgement and logic of uncertainty . Drug Inform J. 1986;;20:383-566.
16 +
Ghajar B, Lanctôt K, Shear N, Naranjo C.  Bayesian differential diagnosis of a cutaneous reaction associated with the administration of sulfonamides . Semin Dermatol. In press.

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