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.

Author(s)
James, Fiona
Goh, Michelle S
Vogrin, Sara
Ng, Irvin
Douglas, Abby P
Holmes, Natasha E
Chua, Kyra Yl
De Luca, Joseph
Sharma, Pooja
Zubrinich, Celia
Aung, Ar K
Gin, Douglas
Lambros, Belinda
Baker, Chris
Foley, Peter
Chong, Alvin H
Thien, Francis
Fok, Jie S
Su, John
Scardamaglia, Laura
Awad, Andrew
Tong, Steven
Johnson, Douglas
Godsell, Jack
Arasu, Alexis
Barnes, Sara
Ojaimi, Samar
Mar, Adrian
Yun, James
Ange, Nikhita
Tong, Winnie W Y
Carr, Andrew
Loprete, Jacqueline
Katelaris, Constance H
Slape, Dana
Keat, Karuna
West, Timothy A
Lee, Monique
Smith, William
Hissaria, Pravin
Sidhu, Shireen
Janson, Sonja
Venkatesan, Sudharsan
Davies, Jane
Lane, Michael J
Redmond, Andrew M
Robertson, Ivan
Legg, Amy
Fernando, Suran
Boyle, Therese
Li, Jamma
Phillips, Elizabeth J
Cleland, Heather
Kern, Johannes S
Trubiano, Jason A
Publication Date
2024-08-01
Abstract
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.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.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%).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 / diagnostic strategies to ascertain drug causality.ANZCTR ACTRN12619000241134. Registered 19 February 2019.
Affiliation
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, 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.
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.
Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia.
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.
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.
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.
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, Austin Health, Australia.
Department of Allergy, Asthma and Clinical Immunology, Alfred Health, Australia.
Department of General Medicine, Alfred Hospital and Monash University, School of Public Health and Preventive Medicine, Australia.
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, St Vincent's Hospital Melbourne and the University of Melbourne, Australia.
Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia.
Department of Dermatology, St Vincent's Hospital Melbourne and the University of Melbourne, Australia.
Department of Respiratory Medicine, Eastern Health and Monash University, Australia.
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.
Department of Dermatology, Eastern Health, Australia.
Department of Dermatology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Australia.
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.
Department of General Medicine and Infectious Diseases Royal Melbourne Hospital, Australia.
Department of General Medicine and Infectious Diseases Royal Melbourne Hospital, Australia.
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Department of Allergy and Immunology, Royal Melbourne Hospital, Australia.
Department of Dermatology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Australia.
Department of Monash Lung Sleep Allergy and Immunology, Clinical Allergy and Immunology, Monash Health, Australia.
Department of Medicine Monash University, Australia.
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.
Department of Dermatology, Monash Health, Australia.
Department of Immunology, Nepean Hospital, NSW, Australia.
Department of Immunology, Nepean Hospital, NSW, Australia.
HIV & Immunology Unit, St Vincent's Hospital, Sydney and School of Clinical Medicine, UNSW Sydney, Australia.
HIV & Immunology Unit, St Vincent's Hospital, Sydney and School of Clinical Medicine, UNSW Sydney, Australia.
HIV & Immunology Unit, St Vincent's Hospital, Sydney and School of Clinical Medicine, UNSW Sydney, Australia.
Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia.
Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia.
Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia.
Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia.
Immunology/Allergy Unit, Campbelltown Hospital, NSW, Australia.
Clinical Immunology and Allergy, Royal Adelaide Hospital, SA, Australia.
Clinical Immunology and Allergy, Royal Adelaide Hospital, SA, Australia.
Department of Dermatology, Royal Adelaide Hospital, SA, Australia.
Department of Infectious Diseases, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
Department of Infectious Diseases, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
Department of Infectious Diseases, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia.
Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia.
Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia.
Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.
Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.
Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.
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.
Victorian Adult Burns Service (VABS), Alfred Hospital, Melbourne, Australia.
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.
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.
Citation
World Allergy Organ J . 2024 Aug 5;17(8):100936. doi: 10.1016/j.waojou.2024.100936. eCollection 2024 Aug.
ISSN
1939-4551
OrcId
Pubmed ID
https://pubmed.ncbi.nlm.nih.gov/39211425/?otool=iaurydwlib
Link
https://hdl.handle.net/10137/13544
Subject
Acute generalized exanthematous pustulosis
DRESS
Delayed hypersensitivity
Drug reaction with eosinophilia and systemic symptoms
Stevens-Johnson syndrome
T-cell mediated hypersensitivity
Toxic epidermal necrolysis
MESH subject
Title
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.
Type of document
Journal Article
Entity Type
Publication

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