Felis ISSN 2398-2950

Skin: adverse drug reactions

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

Contributor(s): Timothy Nuttall, Maarja Uri

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 VetMedResource and PubMed.
  • Voie K L, Lucas B E, Schaeffer D, Kim D, Campbell K L, Lavergne S N (2013)The effect of 'allergenic' and 'nonallergenic' antibiotics on dog keratinocyte viability in vitro. Vet Dermatol24, 501-508 PubMed.
  • Dyer F, Diesel G, Cooles S, Tait A (2012)Suspected adverse events 2011. Vet Rec170(25), 640-643.
  • Padmaja S, Yamini, Palanisamy, Sivanandy (2012)A Study on Assessment, Monitoring and Documentation of Adverse Drug Reactions. International Journal of Pharmacy Teaching & Practices (IJPTP).3(1), 253-256.
  • Voie K L, Campbell K L, Lavergne S N (2012)Drug Hypersensitivity Reactions Targeting the Skin in Dogs and Cats. JVIM26(4), 863-874 PubMed.
  • Howland R H (2011)Understanding and Assessing Adverse Drug Reactions. Journal of Psychosocial Nursing and Mental Health Services 49(10), 13-15.
  • Oberkirchner U, Linder K E, Dunston S, Bizikova P, Olivry T (2011)Metaflumizole-amitraz (Promeris)-associated pustular acnatholytic dermatitis in 22 dogs: evidence suggests drug-triggered pemphigus foliaceus. Vet Dermatol22, 436-448 PubMed.
  • Femiano F, Lanza A, Buonaiuto C, Gombos F, Rullo R, Festa V, Cirillo N (2008)Oral manifestations of adverse drug reactions: Guidelines. Journal of the European Academy of Dermatology and Venereology 22(6), 681-691.
  • 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 Dermatol19, 395-399 PubMed.
  • Wester K, Jönsson A K, Hägg S, Spigset O, Druid H (2008)Incidence of fatal adverse drug reactions: A population base study. Br J Clin Pharmacol65(4), 573-579 PubMed.
  • Wilke R A, Lin D W, Roden D M, Watkins P B, Flockhart D. Zineh I, Krauss R M (2007)Identifying genetic risk factors for serious adverse drug reactions: Current progress and challenges. Nature Reviews Drug Discovery6,  904- 916.
  • Mauldin E A, Palmeiro B S, Goldschmidt M H, Morris D O (2006) Comparison of clinical history and dermatological findings in 29 dogs with severe eosinophilic dermatitis: a retrospective analysis.Vet Dermatol17,  338-347 PubMed.
  • Mellor P J, Roulois A J, Day M J, Blacklaws B A, Knivett S J, Herrtage M E (2005)Neutrophilic dermatitis and immune-mediated haematological disorders in a dog: suspected adverse reaction to carprofen. JSAP46, 237-242 PubMed.
  • Senturk S, Ozel E, Sen A (2005)Clinical Efficacy of Rifampicin for Treatment of Canine Pyoderma. ACTA VET. Brno74, 117-122.
  • Vasilopulos R J, Mackin A, Lavergne S N, Trepanier L A (2005)Nephrotic syndrome associated with administration of sulfadimethoxine/ormetoprim in a dobermann.  JSAP46, 232-236 PubMed.
  • Woodward K N (2005)Veterinary pharmacovigilance. Part 5. Causality and expectedness. Journal of Veterinary Pharmacology and Therapeutics28(2), 203-211 PubMed.
  • Hampshire V A, Doddy F M, Post L O, Koogler T L, Burgess T M, Batten P O, Hudson R, McAdams D R, Brown M A (2004)Adverse drug event reports at the United States Food And Drug Administration Center for Veterinary Medicine. J Am Vet Med Assoc225(4), 533-536.
  • Nuttall T J, Malham T (2004)Successful intravenous human immunoglobulin treatment of drug-induced Stevens-Johnson syndrome in a dog.  JSAP45, 357-361 PubMed.
  • Robson D (2003)Review of the pharmacokinetics, interactions and adverse reactions of cyclosporine in people, dogs and cats. Vet Rec152, 739-748 PubMed.
  • Nichols P R, Morris D O, Beale K M (2001)A Retrospective study of canine and feline cutaneous vasculitis. Vet Dermatol12(5), 255-264 PubMed.
  • Pirmohamed M, & Park B K (2001)Genetic susceptibility to adverse drug reactions. Trends in Pharmacological Sciences22, 298-305 PubMed.
  • Thomas E J, Brennan T A (2000)The incidence and type of preventable adverse events in elderly population-based review of medical records. Br Med J320, 741-744.

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 TJ , (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, Ch8Hypersensitivity Disorders,pp363-364, Ch9Auto-immune and Immune-mediated Dermatoses, pp466-488, Ch10Endrocrine and Metabolic diseases, pp 507-510, Ch18Miscellaneous 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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