ISSN 2398-2950      

Skin: adverse drug reactions

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Synonym(s): Cutaneous adverse drug reactions; ADR; ADE


Introduction

  • Adverse drug reactions (ADR) or adverse drug effects (ADE) are harmful and unintentional reactions that occur at normal therapeutic doses.
  • Term 'drug hypersensitivity' or 'drug allergy' is saved for immune-mediated idiosyncratic ADRs (Type B ADRs, table 1).
  • ADRs are common in human medicine and occur in 16.8% of hospitalized patients; the prevalence of fatal ADRs in human medicine is 3%.
  • Uniform data about prevalence in veterinary healthcare is not available, but they are likely to be under-reported. 
  • The UK Veterinary Medicines Directorate (VMD) received 3755 reports in 2011. Of these, 47% were classified as reaction to a veterinary medication used at manufacturers' recommended dose (31% of the reports lacked sufficient data for further analysis though).
  • The most common drugs associated with veterinary ADRs according to VMD report in 2011 are were:
    • 1. Vaccines (53%).
    • 2. Ectoparaciticides (7.6%).
    • 3. Antimicrobials (7.5%) (mostly beta-lactams and sulphonamides).
    • 4. NSAIDs (6%).
    • 5. Anti-neoplastic agents (0.6%).
  • Human ADRs are most commonly associated with antimicrobials (22%) and NSAIDs (17%).
  • These figures may simply reflect frequency of use rather than specific pathology.
  • It is generally accepted that a veterinary ADR is a significant contributor to patient's morbidity and mortality.

Etiology

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Clinical signs and patterns

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Diagnosis and diagnostic criteria

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Treatment

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Prevention

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Voie K L, Lucas B E, Schaeffer D et al (2013) The effect of 'allergenic' and 'nonallergenic' antibiotics on dog keratinocyte viability in vitro. Vet Dermatol 24 (5), 501-e119 PubMed.
  • Dyer F, Diesel G, Cooles S et al (2012) Suspected adverse events, 2011. Vet Rec 170 (25), 640-643 PubMed.
  • Voie K L, Campbell K L, Lavergne S N (2012) Drug Hypersensitivity Reactions Targeting the Skin in Dogs and Cats. JVIM 26 (4), 863-874 PubMed.
  • Yamini Padmaja S, Palanisamy Sivanandy (2012) A Study on Assessment, Monitoring and Documentation of Adverse Drug Reactions. International Journal of Pharmacy Teaching & Practices (IJPTP) (1), 253-256 IOMC.
  • Howland R H (2011) Understanding and Assessing Adverse Drug Reactions. J Psychosoc Nurs Ment Health Serv 49 (10), 13-15 PubMed.
  • Oberkirchner U, Linder K E, Dunston S et al (2011) Metaflumizole-amitraz (Promeris)-associated pustular acnatholytic dermatitis in 22 dogs: evidence suggests drug-triggered pemphigus foliaceus. Vet Dermatol 22 (5), 436-448 PubMed.
  • Femiano F, Lanza A, Buonaiuto C et al (2008) Oral manifestations of adverse drug reactions: guidelines. J Eur Acad Dermatol Venereol 22 (6), 681-691 PubMed.
  • Murayama N, Midorikawa K, Nagata M (2008) A case of superficial suppurative necrolytic dermatitis of miniature schnauzers with identification of a causative agent using patch test. Vet Dermatol 19 (6), 395-399 PubMed.
  • Wester K, Jönsson A K, Spigset O et al (2008) Incidence of fatal adverse drug reactions: A population base study. Br J Clin Pharmacol 65 (4), 573-579 PubMed.
  • Wilke R A, Lin D W, Roden D M et al (2007) Identifying genetic risk factors for serious adverse drug reactions: Current progress and challenges. Nature Reviews Drug Discovery (11), 904-916 PubMed.
  • Mauldin E A, Palmeiro B S, Goldschmidt M H et al (2006) Comparison of clinical history and dermatological findings in 29 dogs with severe eosinophilic dermatitis: a retrospective analysis. Vet Dermatol 17 (5), 338-347 PubMed.
  • Mellor P J, Roulois A J, Day M J et al (2005) Neutrophilic dermatitis and immune-mediated haematological disorders in a dog: suspected adverse reaction to carprofen. JSAP 46 (5), 237-242 PubMed.
  • Sentürk S, Özel E, Sen A (2005) Clinical Efficacy of Rifampicin for Treatment of Canine Pyoderma. ACTA VET. Brno 74 (1), 117-122 VetMedResource.
  • Vasilopulos R J, Mackin A, Lavergne S N et al (2005) Nephrotic syndrome associated with administration of sulfadimethoxine/ormetoprim in a dobermann. JSAP 46 (5), 232-236 PubMed.
  • Woodward K N (2005) Veterinary pharmacovigilance. Part 5. Causality and expectedness. J Vet Pharmacol Ther​ 28 (2), 203-211 PubMed.
  • Hampshire V A, Doddy F M, Post L O et al (2004) Adverse drug event reports at the United States Food And Drug Administration Center for Veterinary Medicine. J Am Vet Med Assoc 225 (4), 533-536 PubMed.
  • Nuttall T J, Malham T (2004) Successful intravenous human immunoglobulin treatment of drug-induced Stevens-Johnson syndrome in a dog. JSAP 45 (7), 357-361 PubMed.
  • Robson D (2003) Review of the pharmacokinetics, interactions and adverse reactions of cyclosporine in people, dogs and cats. Vet Rec 152 (24), 739-748 PubMed.
  • Nichols P R, Morris D O, Beale K M (2001) A retrospective study of canine and feline cutaneous vasculitis. Vet Dermatol 12 (5), 255-264 PubMed.
  • Pirmohamed M, Park B K (2001) Genetic susceptibility to adverse drug reactions. Trends in Pharmacological Sciences 22 (6), 298-305 PubMed.
  • Thomas E J, Brennan T A (2000) The incidence and type of preventable adverse events in elderly patients: population-based review of medical records. BMJ 320 (7237), 741-744 PubMed.

Other sources of information

  • Veterinary Medicines Directorate:http://www.vmd.defra.gov.uk/index.aspx.
  • European Medicines Agency: http://www.adrreports.eu
  • U.S. Food and Drug Administration, Adverse DRug Experience (ADE) Reports:http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm055369.htm
  • Cribb A E, Peyrou M (2013) Adverse Drug Reactions. In: Small Animal Toxicology. 3rd edition, Elsevier, Ch23, pp275-290.
  • Uri M, Nuttall T J (2013) Adverse drug reactions Importance of reporting ADRs to understand true prevalence. Veterinary Times Vol. 43, No. 43.
  • Miller W H, Griffin C E, Campbell K L (2013) In: Small Animal Dermatology. 7th edition, Elsevier, Ch8 Hypersensitivity Disorders, pp363-364, Ch9 Auto-immune and Immune-mediated Dermatoses, pp466-488, Ch10 Endrocrine and Metabolic diseases, pp 507-510, Ch18 Miscellaneous Skin diseases. pp 706-707.
  • Gross T L, Ihrke P J, Walder E J, Affolter V K (2005) Clinical and Histopathological Diagnosis. In: Skin diseases of the dog and cat.2nd edition. Blackwell. Ch3, pp65-68, Ch4 pp75-78, 80-84.
  • Woodward K N (2008) Veterinary Pharmacovigilance. Adverse Reactions to Veterinary Medicinal Products. Wiley-Blackwell, pp1-14, 393-403, 639-654.

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