World Allergy Organization Journal (Aug 2024)
The Australasian Registry for Severe Cutaneous Adverse Reactions (AUS-SCAR) – Providing a roadmap for closing the diagnostic, patient, and healthcare gaps for a group of rare drug eruptions
- Fiona James, BBiomedSci,
- Michelle S. Goh, MBBS,
- Sara Vogrin, MBiostat,
- Irvin Ng, PhD,
- Abby P. Douglas, PhD,
- Natasha E. Holmes, PhD,
- Kyra YL. Chua, PhD,
- Joseph De Luca, MBBS,
- Pooja Sharma, MD,
- Celia Zubrinich, MPhil,
- Ar K. Aung, MBBS,
- Douglas Gin, MBBS,
- Belinda Lambros, MAdvNursPrac,
- Chris Baker, MBBS,
- Peter Foley, MD,
- Alvin H. Chong, MMed,
- Francis Thien, MD,
- Jie S. Fok, MBBS,
- John Su, MBBS,
- Laura Scardamaglia, MBBS,
- Andrew Awad, MD,
- Steven Tong, PhD,
- Douglas Johnson, PhD,
- Jack Godsell, MBBS,
- Alexis Arasu, MBBS,
- Sara Barnes, MBA,
- Samar Ojaimi, PhD,
- Adrian Mar, MBBS,
- James Yun, PhD,
- Nikhita Ange, MBBCh,
- Winnie W.Y. Tong, PhD,
- Andrew Carr, DSc,
- Jacqueline Loprete, PhD,
- Constance H. Katelaris, PhD,
- Dana Slape, MBBS,
- Karuna Keat, MBBS,
- Timothy A. West, MBBS,
- Monique Lee, MBBS,
- William Smith, PhD,
- Pravin Hissaria, MD,
- Shireen Sidhu, MBBS,
- Sonja Janson, MBBS,
- Sudharsan Venkatesan, MBBS,
- Jane Davies, PhD,
- Michael J. Lane, MBBS,
- Andrew M. Redmond, MBBS,
- Ivan Robertson, MBBS,
- Amy Legg, GradDipClinPharm,
- Suran Fernando, PhD,
- Therese Boyle, MA,
- Jamma Li, MPhil,
- Elizabeth J. Phillips, MD,
- Heather Cleland, MBBS,
- Johannes S. Kern, MD,
- Jason A. Trubiano, PhD
Affiliations
- Fiona James, BBiomedSci
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia; Corresponding author. Department of Infectious Diseases Austin Health, Australia.
- Michelle S. Goh, MBBS
- Department of Dermatology, Alfred Health and Monash University, Department of Medicine, Central Clinical School, Australia; Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia; Department of Dermatology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Australia; Department of Dermatology, Austin Health, Australia; Department of Surgical Oncology (Dermatology), Peter MacCallum Cancer Centre, Melbourne, Australia
- Sara Vogrin, MBiostat
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia
- Irvin Ng, PhD
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia
- Abby P. Douglas, PhD
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; National Centre for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Australia
- Natasha E. Holmes, PhD
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia
- Kyra YL. Chua, PhD
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia
- Joseph De Luca, MBBS
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia
- Pooja Sharma, MD
- Department of Dermatology, Austin Health, Australia
- Celia Zubrinich, MPhil
- Department of Allergy, Asthma and Clinical Immunology, Alfred Health, Australia
- Ar K. Aung, MBBS
- Department of General Medicine, Alfred Hospital and Monash University, School of Public Health and Preventive Medicine, Australia
- Douglas Gin, MBBS
- Department of Dermatology, Alfred Health and Monash University, Department of Medicine, Central Clinical School, Australia
- Belinda Lambros, MAdvNursPrac
- Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia
- Chris Baker, MBBS
- Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia
- Peter Foley, MD
- Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia
- Alvin H. Chong, MMed
- Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia
- Francis Thien, MD
- Department of Respiratory Medicine, Eastern Health and Monash University, Australia
- Jie S. Fok, MBBS
- Department of Respiratory Medicine, Eastern Health and Monash University, Australia; Department of Monash Lung Sleep Allergy and Immunology, Clinical Allergy and Immunology, Monash Health, Australia
- John Su, MBBS
- Department of Dermatology, Eastern Health, Australia
- Laura Scardamaglia, MBBS
- Department of Dermatology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Australia
- Andrew Awad, MD
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia; Department of Dermatology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Australia
- Steven Tong, PhD
- Department of General Medicine and Infectious Diseases Royal Melbourne Hospital, Australia
- Douglas Johnson, PhD
- Department of General Medicine and Infectious Diseases Royal Melbourne Hospital, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
- Jack Godsell, MBBS
- Department of Allergy and Immunology, Royal Melbourne Hospital, Australia
- Alexis Arasu, MBBS
- Department of Dermatology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Australia
- Sara Barnes, MBA
- Department of Monash Lung Sleep Allergy and Immunology, Clinical Allergy and Immunology, Monash Health, Australia; Department of Medicine Monash University, Australia
- Samar Ojaimi, PhD
- Department of Monash Lung Sleep Allergy and Immunology, Clinical Allergy and Immunology, Monash Health, Australia; Department of Medicine Monash University, Australia; Monash Pathology, Monash Health, Australia
- Adrian Mar, MBBS
- Department of Dermatology, Monash Health, Australia
- James Yun, PhD
- Department of Immunology, Nepean Hospital, NSW, Australia
- Nikhita Ange, MBBCh
- Department of Immunology, Nepean Hospital, NSW, Australia
- Winnie W.Y. Tong, PhD
- HIV & Immunology Unit, St Vincent's Hospital, Sydney and School of Clinical Medicine, UNSW Sydney, Australia
- Andrew Carr, DSc
- HIV & Immunology Unit, St Vincent's Hospital, Sydney and School of Clinical Medicine, UNSW Sydney, Australia
- Jacqueline Loprete, PhD
- HIV & Immunology Unit, St Vincent's Hospital, Sydney and School of Clinical Medicine, UNSW Sydney, Australia
- Constance H. Katelaris, PhD
- Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia
- Dana Slape, MBBS
- Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia
- Karuna Keat, MBBS
- Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia
- Timothy A. West, MBBS
- Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia
- Monique Lee, MBBS
- Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia
- William Smith, PhD
- Clinical Immunology and Allergy, Royal Adelaide Hospital, SA, Australia
- Pravin Hissaria, MD
- Clinical Immunology and Allergy, Royal Adelaide Hospital, SA, Australia
- Shireen Sidhu, MBBS
- Department of Dermatology, Royal Adelaide Hospital, SA, Australia
- Sonja Janson, MBBS
- Department of Infectious Diseases, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
- Sudharsan Venkatesan, MBBS
- Department of Infectious Diseases, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
- Jane Davies, PhD
- Department of Infectious Diseases, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
- Michael J. Lane, MBBS
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
- Andrew M. Redmond, MBBS
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
- Ivan Robertson, MBBS
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
- Amy Legg, GradDipClinPharm
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Suran Fernando, PhD
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
- Therese Boyle, MA
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
- Jamma Li, MPhil
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
- Elizabeth J. Phillips, MD
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- Heather Cleland, MBBS
- Victorian Adult Burns Service (VABS), Alfred Hospital, Melbourne, Australia
- Johannes S. Kern, MD
- Department of Dermatology, Alfred Health and Monash University, Department of Medicine, Central Clinical School, Australia; Department of Dermatology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Australia
- Jason A. Trubiano, PhD
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia; Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia; Corresponding author. Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia. Tel.: +61 0394966676.
- Journal volume & issue
-
Vol. 17,
no. 8
p. 100936
Abstract
Background: Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR. Methods: Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites. Results: we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%). Conclusion: In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and in vitro/in vivo diagnostic strategies to ascertain drug causality. Trial registration: ANZCTR ACTRN12619000241134. Registered 19 February 2019.
