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Eosinophilic Drug Reactions Detected by a Prospective Pharmacovigilance Program in a Tertiary Hospital.

Eosinophilic Drug Reactions Detected by a Prospective Pharmacovigilance Program in a Tertiary Hospital.
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Ramírez E, Medrano-Casique N, Tong HY, Bellón T, Cabañas R, Fiandor A, González-Ramos J, Herranz P, Trigo E, Muñoz M, Borobia AM, Carcas AJ, Frías J,


Ramírez E, Medrano-Casique N, Tong HY, Bellón T, Cabañas R, Fiandor A, González-Ramos J, Herranz P, Trigo E, Muñoz M, Borobia AM, Carcas AJ, Frías J, (click to view)

Ramírez E, Medrano-Casique N, Tong HY, Bellón T, Cabañas R, Fiandor A, González-Ramos J, Herranz P, Trigo E, Muñoz M, Borobia AM, Carcas AJ, Frías J,

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British journal of clinical pharmacology 2016 8 20() doi 10.1111/bcp.13096

Abstract
AIM
We conducted a prospective evaluation of all eosinophilic drug reactions (EDRs) through the Prospective Pharmacovigilance Program from Laboratory Signals at Hospital to find out the incidence and distribution of these entities in our hospital, their causative drugs, and predictors.

METHODS
All peripheral eosinophilia >700 cel/mm(3) detected at admission or during hospitalisation, were prospectively monitored over 42 months. The spectrum of the localised or systemic manifestation of EDR, the incidence, the distribution of causative drugs, and the predictors were analysed.

RESULTS
The incidence of EDR was 16.67(95% Poisson-Confidence Interval[CI]:9.90-25.98) per 10,000 admissions. Of 274 cases of EDR, 154(56.2%) cases in 148 patients were asymptomatic hypereosinophilia. In the remaining 120(43.8%) cases, there was other involvement. Skin and soft tissue reactions were detected in 36(13.1%) cases; visceral eosinophilic drug reactions in 19(7.0%) cases; and drug-induced eosinophilic cutaneous and visceral manifestations were detected in the remaining 65(23.7%) cases, 64 of which were potential drug reaction with eosinophilia and systemic symptoms (DRESS). After adjusting for age, sex, and hospitalisation wards, predictors of symptomatic eosinophilia were earlier onset of eosinophilia (hazard ratio[HR],10.49;95%CI:3.13-35.16) higher eosinophil count (HR,8.51;95%CI:3.28-22.08), and a delayed onset of corticosteroids (HR,1.34;95%CI:1.01-1.73). A higher eosinophil count in patients with DRESS was significantly associated with greater impairment of liver function, prolonged hospitalisation, higher cumulative doses of corticosteroids, and if hypogammaglobinaemia was detected, a reactivation of human-herpesvirus 6 was subsequently detected.

CONCLUSIONS
Half (53.3%, 64/120 cases) of symptomatic eosinophilic drug reactions were potential DRESS. The main predictor of severity of EDR was an early severe eosinophilia.

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