Phenotypes of severe cutaneous adverse reactions caused by nonsteroidal anti-inflammatory drugs

Young Min Ye, Suh Young Lee, Young Hee Nam, Young Il Koh, Sae Hoon Kim, Sujeong Kim, Hye Ryun Kang, Min Hye Kim, Jun Gyu Lee, Jungwon Park, Hye Kyung Park, Hyen O. La, Mi Yeong Kim, Seong Ju Park, Yong Eun Kwon, Jae Woo Jung, Sang Hyon Kim, Cheol Woo Kim, Min Seok Yang, Min Gyu KangJin Yong Lee, Joo Hee Kim, Sang Heon Kim, Gyu Young Hur, Young Koo Jee, Hyun Jung Jin, Chan Sun Park, Yi Yeong Jeong

Research output: Contribution to journalArticle

Abstract

Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are common cause of severe cutaneous adverse reactions (SCARs). The present study aimed to investigate the characteristics of SCARs induced by NSAIDs in the Korean SCAR registry. Methods: A retrospective survey of NSAID-induced SCARs recorded between 2010 and 2015 at 27 university hospitals in Korea was conducted. Clinical phenotypes of SCARs were classified into Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS). Causative NSAIDs were classified into 7 groups according to their chemical properties: acetaminophen, and propionic, acetic, salicylic, fenamic and enolic acids. Results: A total of 170 SCARs, consisting of 85 SJS, 32 TEN, 17 SJS-TEN overlap syndrome and 36 DRESS reactions, were induced by NSAIDs: propionic acids (n=68), acetaminophen (n=38), acetic acids (n=23), salicylic acids (n=16), coxibs (n=8), fenamic acids (n=7), enolic acids (n=5) and unclassified (n=5). Acetic acids (22%) and coxibs (14%) accounted for higher portions of DRESS than other SCARs. The phenotypes of SCARs induced by both propionic and salicylic acids were similar (SJS, TEN and DRESS, in order). Acetaminophen was primarily associated with SJS (27%) and was less involved in TEN (10%). DRESS occurred more readily among subjects experiencing coxib-induced SCARs than other NSAID-induced SCARs (62.5% vs. 19.7%, P = 0.013). The mean time to symptom onset was longer in DRESS than in SJS or TEN (19.1 ± 4.1 vs. 6.8 ±1.5 vs. 12.1 ± 3.8 days). SCARs caused by propionic salicylic acids showed longer latency, whereas acetaminophen- and acetic acid-induced SCARs appeared within shorter intervals. Conclusions: The present study indicates that the phenotypes of SCARs may differ according to the chemical classifications of NSAIDs. To establish the mechanisms and incidences of NSAID-induced SCARs, further prospective studies are needed.

Original languageEnglish
Pages (from-to)212-221
Number of pages10
JournalAllergy, Asthma and Immunology Research
Volume11
Issue number2
DOIs
Publication statusPublished - 2019 Mar 1

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Stevens-Johnson Syndrome
Anti-Inflammatory Agents
Phenotype
Drug Hypersensitivity Syndrome
Skin
Pharmaceutical Preparations
Acetaminophen
Propionates
Cyclooxygenase 2 Inhibitors
Acetic Acid
Acetates
Salicylates
Korea
Registries
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine

Cite this

Ye, Young Min ; Lee, Suh Young ; Nam, Young Hee ; Koh, Young Il ; Kim, Sae Hoon ; Kim, Sujeong ; Kang, Hye Ryun ; Kim, Min Hye ; Lee, Jun Gyu ; Park, Jungwon ; Park, Hye Kyung ; La, Hyen O. ; Kim, Mi Yeong ; Park, Seong Ju ; Kwon, Yong Eun ; Jung, Jae Woo ; Kim, Sang Hyon ; Kim, Cheol Woo ; Yang, Min Seok ; Kang, Min Gyu ; Lee, Jin Yong ; Kim, Joo Hee ; Kim, Sang Heon ; Hur, Gyu Young ; Jee, Young Koo ; Jin, Hyun Jung ; Park, Chan Sun ; Jeong, Yi Yeong. / Phenotypes of severe cutaneous adverse reactions caused by nonsteroidal anti-inflammatory drugs. In: Allergy, Asthma and Immunology Research. 2019 ; Vol. 11, No. 2. pp. 212-221.
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abstract = "Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are common cause of severe cutaneous adverse reactions (SCARs). The present study aimed to investigate the characteristics of SCARs induced by NSAIDs in the Korean SCAR registry. Methods: A retrospective survey of NSAID-induced SCARs recorded between 2010 and 2015 at 27 university hospitals in Korea was conducted. Clinical phenotypes of SCARs were classified into Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS). Causative NSAIDs were classified into 7 groups according to their chemical properties: acetaminophen, and propionic, acetic, salicylic, fenamic and enolic acids. Results: A total of 170 SCARs, consisting of 85 SJS, 32 TEN, 17 SJS-TEN overlap syndrome and 36 DRESS reactions, were induced by NSAIDs: propionic acids (n=68), acetaminophen (n=38), acetic acids (n=23), salicylic acids (n=16), coxibs (n=8), fenamic acids (n=7), enolic acids (n=5) and unclassified (n=5). Acetic acids (22{\%}) and coxibs (14{\%}) accounted for higher portions of DRESS than other SCARs. The phenotypes of SCARs induced by both propionic and salicylic acids were similar (SJS, TEN and DRESS, in order). Acetaminophen was primarily associated with SJS (27{\%}) and was less involved in TEN (10{\%}). DRESS occurred more readily among subjects experiencing coxib-induced SCARs than other NSAID-induced SCARs (62.5{\%} vs. 19.7{\%}, P = 0.013). The mean time to symptom onset was longer in DRESS than in SJS or TEN (19.1 ± 4.1 vs. 6.8 ±1.5 vs. 12.1 ± 3.8 days). SCARs caused by propionic salicylic acids showed longer latency, whereas acetaminophen- and acetic acid-induced SCARs appeared within shorter intervals. Conclusions: The present study indicates that the phenotypes of SCARs may differ according to the chemical classifications of NSAIDs. To establish the mechanisms and incidences of NSAID-induced SCARs, further prospective studies are needed.",
author = "Ye, {Young Min} and Lee, {Suh Young} and Nam, {Young Hee} and Koh, {Young Il} and Kim, {Sae Hoon} and Sujeong Kim and Kang, {Hye Ryun} and Kim, {Min Hye} and Lee, {Jun Gyu} and Jungwon Park and Park, {Hye Kyung} and La, {Hyen O.} and Kim, {Mi Yeong} and Park, {Seong Ju} and Kwon, {Yong Eun} and Jung, {Jae Woo} and Kim, {Sang Hyon} and Kim, {Cheol Woo} and Yang, {Min Seok} and Kang, {Min Gyu} and Lee, {Jin Yong} and Kim, {Joo Hee} and Kim, {Sang Heon} and Hur, {Gyu Young} and Jee, {Young Koo} and Jin, {Hyun Jung} and Park, {Chan Sun} and Jeong, {Yi Yeong}",
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Ye, YM, Lee, SY, Nam, YH, Koh, YI, Kim, SH, Kim, S, Kang, HR, Kim, MH, Lee, JG, Park, J, Park, HK, La, HO, Kim, MY, Park, SJ, Kwon, YE, Jung, JW, Kim, SH, Kim, CW, Yang, MS, Kang, MG, Lee, JY, Kim, JH, Kim, SH, Hur, GY, Jee, YK, Jin, HJ, Park, CS & Jeong, YY 2019, 'Phenotypes of severe cutaneous adverse reactions caused by nonsteroidal anti-inflammatory drugs', Allergy, Asthma and Immunology Research, vol. 11, no. 2, pp. 212-221. https://doi.org/10.4168/aair.2019.11.2.212

Phenotypes of severe cutaneous adverse reactions caused by nonsteroidal anti-inflammatory drugs. / Ye, Young Min; Lee, Suh Young; Nam, Young Hee; Koh, Young Il; Kim, Sae Hoon; Kim, Sujeong; Kang, Hye Ryun; Kim, Min Hye; Lee, Jun Gyu; Park, Jungwon; Park, Hye Kyung; La, Hyen O.; Kim, Mi Yeong; Park, Seong Ju; Kwon, Yong Eun; Jung, Jae Woo; Kim, Sang Hyon; Kim, Cheol Woo; Yang, Min Seok; Kang, Min Gyu; Lee, Jin Yong; Kim, Joo Hee; Kim, Sang Heon; Hur, Gyu Young; Jee, Young Koo; Jin, Hyun Jung; Park, Chan Sun; Jeong, Yi Yeong.

In: Allergy, Asthma and Immunology Research, Vol. 11, No. 2, 01.03.2019, p. 212-221.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Phenotypes of severe cutaneous adverse reactions caused by nonsteroidal anti-inflammatory drugs

AU - Ye, Young Min

AU - Lee, Suh Young

AU - Nam, Young Hee

AU - Koh, Young Il

AU - Kim, Sae Hoon

AU - Kim, Sujeong

AU - Kang, Hye Ryun

AU - Kim, Min Hye

AU - Lee, Jun Gyu

AU - Park, Jungwon

AU - Park, Hye Kyung

AU - La, Hyen O.

AU - Kim, Mi Yeong

AU - Park, Seong Ju

AU - Kwon, Yong Eun

AU - Jung, Jae Woo

AU - Kim, Sang Hyon

AU - Kim, Cheol Woo

AU - Yang, Min Seok

AU - Kang, Min Gyu

AU - Lee, Jin Yong

AU - Kim, Joo Hee

AU - Kim, Sang Heon

AU - Hur, Gyu Young

AU - Jee, Young Koo

AU - Jin, Hyun Jung

AU - Park, Chan Sun

AU - Jeong, Yi Yeong

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are common cause of severe cutaneous adverse reactions (SCARs). The present study aimed to investigate the characteristics of SCARs induced by NSAIDs in the Korean SCAR registry. Methods: A retrospective survey of NSAID-induced SCARs recorded between 2010 and 2015 at 27 university hospitals in Korea was conducted. Clinical phenotypes of SCARs were classified into Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS). Causative NSAIDs were classified into 7 groups according to their chemical properties: acetaminophen, and propionic, acetic, salicylic, fenamic and enolic acids. Results: A total of 170 SCARs, consisting of 85 SJS, 32 TEN, 17 SJS-TEN overlap syndrome and 36 DRESS reactions, were induced by NSAIDs: propionic acids (n=68), acetaminophen (n=38), acetic acids (n=23), salicylic acids (n=16), coxibs (n=8), fenamic acids (n=7), enolic acids (n=5) and unclassified (n=5). Acetic acids (22%) and coxibs (14%) accounted for higher portions of DRESS than other SCARs. The phenotypes of SCARs induced by both propionic and salicylic acids were similar (SJS, TEN and DRESS, in order). Acetaminophen was primarily associated with SJS (27%) and was less involved in TEN (10%). DRESS occurred more readily among subjects experiencing coxib-induced SCARs than other NSAID-induced SCARs (62.5% vs. 19.7%, P = 0.013). The mean time to symptom onset was longer in DRESS than in SJS or TEN (19.1 ± 4.1 vs. 6.8 ±1.5 vs. 12.1 ± 3.8 days). SCARs caused by propionic salicylic acids showed longer latency, whereas acetaminophen- and acetic acid-induced SCARs appeared within shorter intervals. Conclusions: The present study indicates that the phenotypes of SCARs may differ according to the chemical classifications of NSAIDs. To establish the mechanisms and incidences of NSAID-induced SCARs, further prospective studies are needed.

AB - Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are common cause of severe cutaneous adverse reactions (SCARs). The present study aimed to investigate the characteristics of SCARs induced by NSAIDs in the Korean SCAR registry. Methods: A retrospective survey of NSAID-induced SCARs recorded between 2010 and 2015 at 27 university hospitals in Korea was conducted. Clinical phenotypes of SCARs were classified into Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS). Causative NSAIDs were classified into 7 groups according to their chemical properties: acetaminophen, and propionic, acetic, salicylic, fenamic and enolic acids. Results: A total of 170 SCARs, consisting of 85 SJS, 32 TEN, 17 SJS-TEN overlap syndrome and 36 DRESS reactions, were induced by NSAIDs: propionic acids (n=68), acetaminophen (n=38), acetic acids (n=23), salicylic acids (n=16), coxibs (n=8), fenamic acids (n=7), enolic acids (n=5) and unclassified (n=5). Acetic acids (22%) and coxibs (14%) accounted for higher portions of DRESS than other SCARs. The phenotypes of SCARs induced by both propionic and salicylic acids were similar (SJS, TEN and DRESS, in order). Acetaminophen was primarily associated with SJS (27%) and was less involved in TEN (10%). DRESS occurred more readily among subjects experiencing coxib-induced SCARs than other NSAID-induced SCARs (62.5% vs. 19.7%, P = 0.013). The mean time to symptom onset was longer in DRESS than in SJS or TEN (19.1 ± 4.1 vs. 6.8 ±1.5 vs. 12.1 ± 3.8 days). SCARs caused by propionic salicylic acids showed longer latency, whereas acetaminophen- and acetic acid-induced SCARs appeared within shorter intervals. Conclusions: The present study indicates that the phenotypes of SCARs may differ according to the chemical classifications of NSAIDs. To establish the mechanisms and incidences of NSAID-induced SCARs, further prospective studies are needed.

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