Abstract
OBJECTIVES: The purpose in the first year project was to set up the multicenter registry of patients diagnosed with SCARs in Thailand and to evaluate the diagnostic values of interferon-gamma ELISpot assay (IFN-γ ELISpot) for culprit drug identification compared to skin patch test in selected cases METHODS Patients diagnosed with drug-induced SCAR over a one-year period from 6 university hospitals were analyzed for demographic data, drug allergy phenotypes, and the causative drugs. Skin patch test and IFN-γ ELISpot assay were examined in selected cases for culprit drug identification. RESULTS There were 113 SCAR patients (42 males, 71 females) with the average age of 51.7±1.8 years, comprising of 50 Stevens-Johnson/toxic epidermal necrolysis (SJS/TEN), 46 drug rash with eosinophilia and systemic symptoms (DRESS), and 17 acute generalized exanthematous pustulosis (AGEP), respectively. Drug-specific IFN- γ releasing cells were detectable in 38.9% (44/113) of SCAR cases with the average frequencies of 214.8±52.5 cells/106 peripheral blood mononuclear cells. Among 30 SCAR patients, 6 cases (20% of them) had positive skin patch test while 16 cases (53.3% of them) had positive IFN-γ ELISpot assay. CONCLUSIONS SJS/TEN contributed to almost half of patients with severe cutaneous adverse reaction in Thailand. IFN-γ ELISpot assay helped to identify the culprit drugs in nearly 40% of the cases and yielded higher sensitivity than skin patch testing.
