RISK FACTORS ASSOCIATED WITH DRESS SYNDROME PRODUCED BY AROMATIC AND NONAROMATIC ANTIEPILEPTIC DRUGS
De Silva NP, Kochen S. Eur J Clin Pharmacol. 2009;67:463-470.
This descriptive study sought to describe the clinical manifestations and treatment associated with DRESS (drug reaction associated with eosinophilia and systemic symptoms) produced by aromatic and nonaromatic antiepileptic drugs (AEDs). DRESS usually develops at the beginning of treatment and is characterized by rash, fever, and eosinophilia, and the incidence is 0.4 cases per 1 000 000 general population. The pathology is unknown; however, there is an association with immunological or genetic factors.
This was a single hospital study with patients (n = 80 with the average age of 30.8 years) who were treated with AEDs and developed DRESS. All patients had dermatological manifestations, eosinophilia, and hematological and hepatic manifestations that could be attributed to use of AEDs. Treatment included removal of the drug from the treatment regimen, symptomatic management, life support, and use of corticosteroids. There was no mortality associated with this study. Systemic manifestations resolved between 1 and 6 months of age. The authors did state a 10% mortality associated with other studies.
The authors conclude future studies should focus on AED selection and elucidating the pathogenesis, genetic basis, and possible associated risk factors of DRESS.
TODDLERS REQUIRING PEDIATRIC INTENSIVE CARE UNIT ADMISSION FOLLOWING AT-HOME EXPOSURE TO BUPRENORPHINE/NALAXONE
Pedapati EV, Bateman ST. Pediatr Crit Care Med. 2011;12(2):e102-e106.
Current treatment for opioid addiction includes methadone-based and buprenorphine-based maintenance therapy. Physicians can prescribe and manage buprenorphine-based maintenance therapy from an office-based practice, increasing the availability of treatment. The authors state there have been increasing reports of a growing number of children with unintentional buprenorphine exposure. In this retrospective study, the researchers sought to determine the prevalence of symptomatic buprenorphine exposure to children younger than 3 years, the severity of the toxicity, and effective interventions.
The authors found at an academic medical center that 9 of 33 children admitted for toxic ingestion had exposure to buprenorphine, and all occurred at the child's place of residence. Clinical signs of opioid toxicity were present in all 9 cases including drowsiness or lethargy, followed by miosis (n = 6) and respiratory depression (n = 5). Of these, 6 children were treated with naloxone.
The authors found naloxone to be an effective agent for reversal, but because of the long action and high affinity, they found that higher doses or continuous infusion may be required. The authors further concluded that adults on buprenorphine should be educated of the risks to young children and appropriate storage of the medication.