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drug reaction with Eosinophilia and Systemic Symptoms： Retrospective Analysis of 104 Cases over One Decade

Chinese Medical Journal 2017年第8期130卷 943-949页

作者： Li Wang Xue-Ling Mei Department of Dermatology Allergy and Clinical Immunology Centre Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Background： drug reaction with eosinophilia and systemic symptoms （DRESS） is a severe, life-threatening disorder caused by drugs. In the present study, we tried to explore the types of DRESS-inducing drugs, incubation period, features of skin rashes, accompanying visceral damage, and effectiveness of glucocorticoid therapy so as to inform clinical practice. Methods： Patients diagnosed with a drug-induced rash, dermatitis, and DRESS admitted to our hospital from January 2006 to December 2015 were included in the study. The diagnosis followed the criteria and scoring system set by the European Registry of Severe Cutaneous Adverse reactions. Statistical analyses were carried out using SPSS version 17.0 （IBM, Armonk, NY, USA）, and a value ofP 〈 0.05 was considered statistically significant. Results： Among 104 patients, 38 were male and 66 female （aged 18-83 years）. The latent period was 13 （interquartile range [IQR]： 10-17） days. The most common allergy-inducing drugs were antibiotics （n = 37, 35.6%）, followed by antiepileptic drugs and traditional Chinese medicines （TCMs）. Eighty-two cases （78.8%） had rash with area 〉50% body surface area （BSA）. Liver damage occurred in 90% of cases. Patients were divided into oral antihistamine group and glucocorticoid/immunosuppressive agent/intravenous immunoglobulin （IVIG） group. Sex, age, incubation period, duration of hospital stay, and the number of patients with body temperature 〉38.5℃ were not significantly different between the two groups. However, the number of patients meeting the criteria of＂definite＂ and ＂probable＂（X2 =5.852, P = 0.016）, with an eosinophilic granulocyte count of〉1.5 x10^9/L 0,2 7.129, P = 0.008）, and with rash area of〉50% BSA （X2 = 4.750, P = 0.029）, was significantly different. Conclusions： Antibiotics were associated with allergic reactions, but TCMs also had an important role. Allergy resulting from repeat use of the same drug was more severe with a shorter incubation period. The most typical rash was

关键词： drug reaction drug reaction with Eosinophilia and Systemic Symptoms Syndrome Hypersensitivity reaction

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Transitioning patients with inflammatory bowel disease from hospital-based to rapid home-based infliximab: A stepwise, safety and patient-orientated process towards sustainability

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World Journal of Gastroenterology 2020年第36期26卷 5437-5449页

作者： Anuj Bohra Qurat-Al-Ain Rizvi Charlotte Yuen Yu Keung Abhinav Vasudevan Daniel R van Langenberg Department of Gastroenterology Eastern HealthBox Hill 3128VictoriaAustralia Eastern Health Clinical School Monash UniversityBox Hill 3128VictoriaAustralia

BACKGROUND Infliximab and other intravenous biologic infusions are increasingly used for chronic disorders like inflammatory bowel disease(IBD).Rapid infliximab and home-based infusions are attractive solutions to address resource and capacity issues for infusion centres,yet infliximab infusion reactions reportedly occur in up to 25%of patients with IBD,even at the manufacturers’recommended infusion duration of 2 *** To evaluate the safety,cost and patient satisfaction of transitioning from hospitalbased,standard 2 h to rapid home-based,30-min infliximab *** All patients receiving rapid infliximab infusions for IBD between 2014 to 2017(39 mo)were compared with those who received standard two-hour IFX infusions between 2005-2013(96 mo)at a single IBD ***(per-infusion and perindividual)including adverse drug reactions(ADR),duration(based on needledeparture time)and other clinical data were extracted from electronic medical *** logistical regression analysis assessed factors potentially associated with increased risk of ADRs to rapid *** primary outcome was the safety[as per relative risk(RR)of (ADR)of(1)rapid 30 m infusions(both hospital-and home-based)vs standard 2 h infliximab ***,relative cost per infusion and patient satisfaction and productivity were evaluated in rapid infusion recipients who transitioned to home-based *** Of 129 patients who received 1461 rapid IFX infusions(2014-2017)were compared with 169 patients who received 2214 standard IFX infusions(2005-2013).Within the rapid cohort,55(42.6%)were males,median age 42 years(range 18,86),114(84%)had Crohn’s disease(CD)with a median disease duration 5 years(0,36).Median needle to departure time was higher in the standard than the rapid protocol group,108(70,253)vs 50(33,90)min,(P<0.001),with a per infusion cost of$AUD 107.50 vs$49.77,respectively(both P<0.001).There was no difference in median infusion duration or costs between rapi

关键词： Inflammatory bowel disease Infliximab Safety Cost Therapy drug reaction

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