Fixed drug eruptions and oral rechallenge

Monitoring the acute response in severe hypersensitivity reactions to drugs

“…As shown in Table 1 [7], serum TNF-a and IL-8 levels were elevated dramatically at 3 h after clinical challenge, the earliest time point we examined, at which time slight erythema appeared as the initial symptoms [10]. The marked elevation of TNF-a and IL-8 levels was associated with an onset of a low fever, but not with abnormal laboratory findings, such as elevated C-reative protein (CRP) and erythrocyte sedimentation rate (ESR).…”

“…A complicated multistep process from the initiation of inflammatory responses to eventual tissue damage observed in severe ADR lesions could be examined in sequence by following the evolution of individual FDE lesions after clinical challenge with the causative drug, because in this entity controlled administration is safe and is still the most reliable method for establishing the causative drug in FDE [6]. The similarity between SJS/TEN and FDE, particularly the generalized form of FDE, in clinical features and histologic patterns has been proposed by several authors [7][8][9].…”

“…Serum cytokine levels before and after clinical challenge in a patient with generalized fixed drug eruption (modified from the data presented in reference[7])…”

An Updated Review of the Diagnostic Methods in Delayed Drug Hypersensitivity

“…Studies on cytokine measurements after clinical drug challenge in patients with the generalized form of FDE clinically and histologically mimicking SJS/TEN have reported an initial increase in serum TNF-α and IL-8 followed by elevation in IFN-γ, IL-6 and IL-10 levels (Kauppinen, 1991;Correia et al, 2002;Shiohara et al, 2015). Similarly, dosage of levels for multiple cytokines/ chemokines in order to identify essential markers has also been attempted with studies identifying a significant increase in IL-6 and interferon gamma-produced protein 10 (IP-10) in SJS/TEN and DRESS as well as IL-16 in FDE, SJS and DRESS but not TEN (Shiohara et al, 2015).…”