Advances in Diagnosis and Management of Severe Cutaneous Adverse Reactions

At the American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting last month, Elizabeth J. Phillips, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, gave a presentation during the Creating Knowledge for Our Future lectureship, called Paradigm Shifts in Drug Allergy.

In this exclusive MedPage Today video, Dr. Phillips discusses her address, which highlighted the advances in the diagnosis and management of severe cutaneous adverse reactions (SCARs) and what tools physicians need to recognize and mitigate patient fears.

Following is a transcript of her remarks:

I think a big part of these severe reactions is just awareness, and trying to alleviate the fear associated with them. But at the same time empower physicians with the tools they need to recognize them, to diagnose, to manage them, and to mitigate harm associated with them.

The science is very exciting. The science hopefully will make it easier for physicians in practice to both recognize and avoid these types of reactions. But where we are now, we still have to pull out both a clinical toolkit and a research toolkit. We're not seamlessly across that. I mean, in all areas, it's rare to have any area of medicine where there's examples of taking something from discovery to translation in almost every discipline, but it's rare for everything to have been solved.

And with SCAR reactions, the important thing is for physicians who are at the interface ... of clinical care, to be able to recognize them and get the patients to the right place. And for more specialized physicians like allergists, dermatologists and critical care specialists to be able to understand what is necessary to get these patients through the most difficult part of their acute setting, and then triage them into the appropriate follow-up, so they mitigate harm from morbidities associated with these diseases.

The big thing about these and why physicians are fearful is they know certain drugs are associated with these, but they're scared because they haven't seen a lot. Because they're not common enough that going through medical school or any professional training that any one physician would've seen more than one or two, and some physicians wouldn't have seen any at all. And so it becomes a bit of a self-fulfilling prophecy, if you will, because the trainers that are training the trainees are not equipped with the knowledge. And so the students don't get the knowledge.

So, I mean, number one is obviously to think of it and to have the toolkit to do that. Number two is basic recognition and getting the patient into the right emergency care context and stopping [not only] the drug that is likely to be implicated, but all potential implicated drugs as soon as possible. And so those are kind of the key messages for the physician who is faced with seeing potential severe cutaneous adverse drug reactions.

And I guess the messages across all of these diseases, of which there are three main ones that I focused on in my presentation, but the key message is that for any of these, when they present early, they may not have the full complement of symptom complexes. And so you have to kind of recognize based on the drug that they've been taking, that this is a possibility.

And so it sounds complex and it sounds like it would be a tall order, but, in fact, pretty much for all of these -- I know we've had a big onslaught of immunotherapies and complex oncology treatments -- but aside from those, the common, what we call small-molecule drugs, which are just the pills that are commonly prescribed in in-hospital and outpatient settings, the real causes of these severe reactions have not changed considerably over the last 15 to 20 years.

So we're asking physicians to remember four to five top drugs, high-risk drugs, and there's a considerable overlap between these different clinical entities that I'm talking about that we put under the broad umbrella of severe cutaneous adverse drug reactions.

Comment