Full text

Turn on search term navigation

© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Introduction

Severe cutaneous adverse reactions (SCAR) are a group of T cell-mediated hypersensitivities associated with significant morbidity, mortality and hospital costs. Clinical phenotypes include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalised exanthematous pustulosis (AGEP). In this Australasian, multicentre, prospective registry, we plan to examine the clinical presentation, drug causality, genomic predictors, potential diagnostic approaches, treatments and long-term outcomes of SCAR in Australia and New Zealand.

Methods and analysis

Adult and adolescent patients with SCAR including SJS, TEN, DRESS, AGEP and another T cell-mediated hypersensitivity, generalised bullous fixed drug eruption, will be prospectively recruited. A waiver of consent has been granted for some sites to retrospectively include cases which result in early mortality. DNA will be collected for all prospective cases. Blood, blister fluid and skin biopsy sampling is optional and subject to patient consent and site capacity. To develop culprit drug identification and prevention, genomic testing will be performed to confirm human leukocyte antigen (HLA) type and ex vivo testing will be performed via interferon-γ release enzyme linked immunospot assay using collected peripheral blood mononuclear cells. The long-term outcomes of SCAR will be investigated with a 12-month quality of life survey and examination of prescribing and mortality data.

Ethics and dissemination

This study was reviewed and approved by the Austin Health Human Research Ethics Committee (HREC/50791/Austin-19). Results will be published in peer-reviewed journals and presented at relevant conferences.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12619000241134).

Details

Title
Study protocol: Australasian Registry of Severe Cutaneous Adverse Reactions (AUS-SCAR)
Author
James, Fiona 1   VIAFID ORCID Logo  ; Goh, Michelle S Y 2 ; Mouhtouris, Effie 1 ; Vogrin, Sara 3 ; Chua, Kyra Y L 1 ; Holmes, Natasha E 4 ; Awad, Andrew 1 ; Ana-Maria Copaescu 1   VIAFID ORCID Logo  ; De Luca, Joseph F 1   VIAFID ORCID Logo  ; Zubrinich, Celia 5 ; Gin, Douglas 6 ; Cleland, Heather 7 ; Douglas, Abby 8 ; Kern, Johannes S 9 ; Katelaris, Constance H 10 ; Thien, Francis 11 ; Barnes, Sara 12 ; Yun, James 13 ; Tong, Winnie 14 ; Smith, William B 15 ; Carr, Andrew 16 ; Anderson, Tara 17 ; Legg, Amy 18 ; Bourke, Jack 19 ; Mackay, Laura K 20 ; Ar Kar Aung 21 ; Phillips, Elizabeth J 22 ; Trubiano, Jason 23   VIAFID ORCID Logo 

 Centre for Antibiotic Allergy & Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia 
 Department of Dermatology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia; Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia 
 Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia 
 Centre for Antibiotic Allergy & Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia 
 Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia 
 Department of Dermatology, Alfred Hospital, Melbourne, Victoria, Australia 
 Victorian Adult Burns Service, Alfred Hospital, Melbourne, Victoria, Australia 
 Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia 
 Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Dermatology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia 
10  Department of Immunology, Campbelltown Hospital, Campbelltown, New South Wales, Australia 
11  Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia; Department of Respiratory and Sleep Medicine, Eastern Health, Box Hill, Victoria, Australia 
12  Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, Victoria, Australia 
13  Immunology and Rheumatology, Nepean Hospital, Penrith, New South Wales, Australia 
14  HIV & Immunology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia 
15  Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia 
16  HIV & Immunology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia 
17  Department of Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia 
18  Pharmacy Department, Royal Darwin Hospital, Casuarina, Northern Territory, Australia 
19  Department of Immunology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia 
20  Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia 
21  Department of General Medicine, Alfred Hospital, Melbourne, Victoria, Australia 
22  Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia; Departments of Medicine, Dermatology, Pathology, Microbiology, Immunology and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA 
23  Centre for Antibiotic Allergy & Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia 
First page
e055906
Section
Immunology (including allergy)
Publication year
2022
Publication date
2022
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2704370231
Copyright
© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.