2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T41f,- **Dupilumab/eosinophilia in children**: ~20% of children on dupilumab had early eosinophil increases (≥500 cells/µL at Week 12), but this did not affect long-term efficacy or safety. - **Gene-microbiome/wheeze**: 17q12-21 SNPs (esp. Gasdermin B rs7216389TT) interacted with MSH airway microbiota to increase early-life wheeze risk; CDSB microbiota interactions were protective. - **miR-149/skin**: Loss of miR-149 worsened psoriasis-like and atopic dermatitis-like inflammation in mice; restoring miR-149 in human biopsies suppressed inflammatory markers. - **Sulfasalazine SCARs**: HLA-B\*38:02 (OR 11.69 for SJS/TEN), HLA-B\*39:01 (OR 24.78 for DRESS), and HLA-B\*13:01 (OR 7.00 for DRESS); a 4-allele panel had 84.8% sensitivity in Chinese populations. - **SERPING1 SP variants**: 6 of 33 signal peptide variants caused poor C1-INH synthesis; protein aggregates observed in ER for L10R, G17R, S22L. - **Tezepelumab remission (TERESA)**: 34.6% of patients achieved clinical remission at 52 weeks; 47.4% biologic-naive vs 20.0% biologic-experienced.31:T451,The 29 participants, aged 26 to 76 years, were 66% female and 69% White and had experienced SJS/TEN from a wide range of drugs. Patients experienced support while in the hospital, but once discharged, felt isolated and without support to understand the potential sustained impacts of SJS/TEN in their lives and the lives of their family members. Patients experienced ongoing biological symptoms, such as skin issues, debilitating visual impairment, blindness, and lack of functional autonomy. Psychological impacts included symptoms of anxiety, obsessive thinking, flashbacks, and depression. Socially, some survivors expressed a sense of abandonment and described negative impacts on their careers. Survivors also expressed frustration and isolation with having to navigate posthospital care alone. There was a lack of preemptive discharge education and SJS/TEN-specific planning. Lack of physician knowledge about SJS/TEN was particularly noted and survivors turned to the internet for guidance instead of receiving direction from their physicians. Medical distrust among survivors was frequently noted.32:T9f0,Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) survivors experience substantial long-term sequelae. Research on physical symptoms experienced during acute hospitalization is well documented, but limited studies have been completed on the long-term biopsychosocial effects of SJS/TEN, particularly from the patient's perspective. To increase the understanding of the long-term complications of SJS/TEN. This qualitative investigation was completed from within a community-based study, the SJS Survivors Study, using a semistructured, in-depth interview guide to query participants about their SJS/TEN experience postdischarge from the hospital. Interviews took place by phone from July 2021 through August 2023. This study included adults who experienced SJS/TEN within the United States. A biopsychosocial theory-based framework and hierarchical coding system were utilized to understand the long-term life impacts of survivors of SJS/TEN. The 29 participants, aged 26 to 76 years, were 66% female and 69% White and had experienced SJS/TEN from a wide range of drugs. Patients experienced support while in the hospital, but once discharged, felt isolated and without support to understand the potential sustained impacts of SJS/TEN in their lives and the lives of their family members. Patients experienced ongoing biological symptoms, such as skin issues, debilitating visual impairment, blindness, and lack of functional autonomy. Psychological impacts included symptoms of anxiety, obsessive thinking, flashbacks, and depression. Socially, some survivors expressed a sense of abandonment and described negative impacts on their careers. Survivors also expressed frustration and isolation with having to navigate posthospital care alone. There was a lack of preemptive discharge education and SJS/TEN-specific planning. Lack of physician knowledge about SJS/TEN was particularly noted and survivors turned to the internet for guidance instead of receiving direction from their physicians. Medical distrust among survivors was frequently noted. The findings highlight the need for postdischarge care coordination among patients and their primary physicians, including mental health support. This care coordination should be arranged prior to discharge to ensure the availability of adequate support and optimal health outcomes. It is essential that clinicians and researchers prioritize the understanding of long-term sequelae of SJS/TEN and improve current discharge education and protocols for patients and their families.33:Te19, Importance Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) survivors experience substantial long-term sequelae. Research on physical symptoms experienced during acute hospitalization is well documented, but limited studies have been completed on the long-term biopsychosocial effects of SJS/TEN, particularly from the patient’s perspective. Objective To increase the understanding of the long-term complications of SJS/TEN. Design, Setting, and Participants This qualitative investigation was completed from within a community-based study, the SJS Survivors Study, using a semistructured, in-depth interview guide to query participants about their SJS/TEN experience postdischarge from the hospital. Interviews took place by phone from July 2021 through August 2023. This study included adults who experienced SJS/TEN within the United States. Main Outcome and Measures A biopsychosocial theory-based framework and hierarchical coding system were utilized to understand the long-term life impacts of survivors of SJS/TEN. Results The 29 participants, aged 26 to 76 years, were 66% female and 69% White and had experienced SJS/TEN from a wide range of drugs. Patients experienced support while in the hospital, but once discharged, felt isolated and without support to understand the potential sustained impacts of SJS/TEN in their lives and the lives of their family members. Patients experienced ongoing biological symptoms, such as skin issues, debilitating visual impairment, blindness, and lack of functional autonomy. Psychological impacts included symptoms of anxiety, obsessive thinking, flashbacks, and depression. Socially, some survivors expressed a sense of abandonment and described negative impacts on their careers. Survivors also expressed frustration and isolation with having to navigate posthospital care alone. There was a lack of preemptive discharge education and SJS/TEN-specific planning. Lack of physician knowledge about SJS/TEN was particularly noted and survivors turned to the internet for guidance instead of receiving direction from their physicians. Medical distrust among survivors was frequently noted. Conclusions and Relevance The findings highlight the need for postdischarge care coordination among patients and their primary physicians, including mental health support. This care coordination should be arranged prior to discharge to ensure the availability of adequate support and optimal health outcomes. It is essential that clinicians and researchers prioritize the understanding of long-term sequelae of SJS/TEN and improve current discharge education and protocols for patients and their families. 34:Tb58,Carriage of HLA-B*58:01 has been shown to be associated with allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) in many populations globally; however, there is a critical need to investigate whether this is generalizable to populations of mixed ancestry, such as those in the US. To assess the association of human leukocyte antigen (HLA) class I and II in a cohort of US patients who received a diagnosis of allopurinol-induced SJS/TEN or DRESS compared with allopurinol-tolerant and population control participants. This genetic association study included consenting individuals who had specialist-adjudicated allopurinol-induced SJS/TEN or DRESS (collectively allopurinol-induced severe cutaneous adverse reactions [SCARs]) between January 1, 2015, and December 31, 2024. HLA carriage in these individuals was compared with allopurinol-tolerant and population control participants identified through the Vanderbilt University Medical Center biobank, which includes 94 489 individuals with imputed HLA class I and II typing from genotyping array data. Data were analyzed from January 2025 to August 2025. The main outcome measure was the association of HLA class I and II alleles with allopurinol-induced SCARs. HLA class I and II conditional logistic regression case-control analyses were performed between patients with allopurinol-induced SCARs and both population control and allopurinol-tolerant control participants matched on age, sex, and self-identified race. Odds ratios (ORs) and 95% CIs were reported, with Bonferroni-corrected P < .05. This genetic association study used conditional logistic regression analyses and included 16 patients with allopurinol-induced SCAR (mean [SD] age, 61.1 [12.6] years; 9 female patients [56.25%] and 7 male patients [43.75%]) and 160 allopurinol-tolerant control participants matched 10:1. Two HLA class I alleles were found to be independently associated with increased risk of allopurinol-induced SCAR: HLA-B*58:01 (OR, 28.0 [95% CI, 8.6-100.6]) and HLA-A*34:02 (OR, 20.6 [95% CI, 3.3-131.1]). No HLA class II alleles meeting the Bonferroni-corrected P < .05 level of significance were identified. These findings suggest that although HLA-B*58:01 was found to be associated with allopurinol-induced SCARs, generalizing findings from previous studies, the allele was absent in more than one-third of the patient cohort and is therefore an incomplete indicator of risk. Importantly, in the US allopurinol-induced SCAR cohort, HLA-A*34:02 was found to be a second independent genetic risk factor for allopurinol-induced SCARs. These findings underscore the need to conduct population-based studies that both reproduce known and uncover novel HLA associations to reduce harm through contributions to screening, risk stratification, and diagnosis.35:T1098, Importance Carriage of HLA-B*58:01 has been shown to be associated with allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) in many populations globally; however, there is a critical need to investigate whether this is generalizable to populations of mixed ancestry, such as those in the US. Objective To assess the association of human leukocyte antigen (HLA) class I and II in a cohort of US patients who received a diagnosis of allopurinol-induced SJS/TEN or DRESS compared with allopurinol-tolerant and population control participants. Design, Setting, and Participants This genetic association study included consenting individuals who had specialist-adjudicated allopurinol-induced SJS/TEN or DRESS (collectively allopurinol-induced severe cutaneous adverse reactions [SCARs]) between January 1, 2015, and December 31, 2024. HLA carriage in these individuals was compared with allopurinol-tolerant and population control participants identified through the Vanderbilt University Medical Center biobank, which includes 94 489 individuals with imputed HLA class I and II typing from genotyping array data. Data were analyzed from January 2025 to August 2025. Main Outcomes and Measures The main outcome measure was the association of HLA class I and II alleles with allopurinol-induced SCARs. HLA class I and II conditional logistic regression case-control analyses were performed between patients with allopurinol-induced SCARs and both population control and allopurinol-tolerant control participants matched on age, sex, and self-identified race. Odds ratios (ORs) and 95% CIs were reported, with Bonferroni-corrected P &lt; .05. Results This genetic association study used conditional logistic regression analyses and included 16 patients with allopurinol-induced SCAR (mean [SD] age, 61.1 [12.6] years; 9 female patients [56.25%] and 7 male patients [43.75%]) and 160 allopurinol-tolerant control participants matched 10:1. Two HLA class I alleles were found to be independently associated with increased risk of allopurinol-induced SCAR: HLA-B*58:01 (OR, 28.0 [95% CI, 8.6-100.6]) and HLA-A*34:02 (OR, 20.6 [95% CI, 3.3-131.1]). No HLA class II alleles meeting the Bonferroni-corrected P &lt; .05 level of significance were identified. Conclusions and Relevance These findings suggest that although HLA-B*58:01 was found to be associated with allopurinol-induced SCARs, generalizing findings from previous studies, the allele was absent in more than one-third of the patient cohort and is therefore an incomplete indicator of risk. Importantly, in the US allopurinol-induced SCAR cohort, HLA-A*34:02 was found to be a second independent genetic risk factor for allopurinol-induced SCARs. These findings underscore the need to conduct population-based studies that both reproduce known and uncover novel HLA associations to reduce harm through contributions to screening, risk stratification, and diagnosis. 36:T9f6,Antibiotics are an important risk for Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), which are the most severe types of drug hypersensitivity reaction with a mortality rate up to 50%. To our knowledge, no global systematic review has described antibiotic-associated SJS/TEN. To evaluate the prevalence of antibiotics associated with SJS/TEN worldwide. The MEDLINE and Embase databases were searched for experimental and observational studies that described SJS/TEN risks since database inception to February 22, 2022. Included studies adequately described SJS/TEN origins and specified the antibiotics associated with SJS/TEN. Two reviewers (E.Y.L. and C.K.) independently selected the studies, extracted the data, and assessed the risk of bias. A meta-analysis using a random-effects model was performed in the studies that described patient-level associations. Subgroup analyses were performed to explore the heterogeneity. The risk of bias was assessed using the Joanna Briggs Institute checklist, and the certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Prevalence of antibiotic-associated SJS/TEN was presented as pooled proportions with 95% CIs. Among the 64 studies included in the systematic review, there were 38 studies that described patient-level associations; the meta-analysis included these 38 studies with 2917 patients to determine the prevalence of single antibiotics associated with SJS/TEN. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24%-33%), with moderate certainty of evidence. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22%-44%) of cases, followed by penicillins (22%; 95% CI, 17%-28%), cephalosporins (11%; 95% CI, 6%-17%), fluoroquinolones (4%; 95% CI, 1%-7%), and macrolides (2%; 95% CI, 1%-5%). There was a statistically significant heterogeneity in the meta-analysis, which could be partially explained in the subgroup analysis by continents. The overall risk of bias was low using the Joanna Briggs Institute checklist for case series. In this systematic review and meta-analysis of all case series, antibiotics were associated with more than one-quarter of SJS/TEN cases described worldwide, and sulfonamide antibiotics remained the most important association. These findings highlight the importance of antibiotic stewardship, clinician education and awareness, and weighing the risk-benefit assessment of antibiotic choice and duration.37:Td0d,ImportanceAntibiotics are an important risk for Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), which are the most severe types of drug hypersensitivity reaction with a mortality rate up to 50%. To our knowledge, no global systematic review has described antibiotic-associated SJS/TEN.ObjectiveTo evaluate the prevalence of antibiotics associated with SJS/TEN worldwide.Data SourcesThe MEDLINE and Embase databases were searched for experimental and observational studies that described SJS/TEN risks since database inception to February 22, 2022.Study SelectionIncluded studies adequately described SJS/TEN origins and specified the antibiotics associated with SJS/TEN.Data Extraction and SynthesisTwo reviewers (E.Y.L. and C.K.) independently selected the studies, extracted the data, and assessed the risk of bias. A meta-analysis using a random-effects model was performed in the studies that described patient-level associations. Subgroup analyses were performed to explore the heterogeneity. The risk of bias was assessed using the Joanna Briggs Institute checklist, and the certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.Main Outcomes and MeasuresPrevalence of antibiotic-associated SJS/TEN was presented as pooled proportions with 95% CIs.ResultsAmong the 64 studies included in the systematic review, there were 38 studies that described patient-level associations; the meta-analysis included these 38 studies with 2917 patients to determine the prevalence of single antibiotics associated with SJS/TEN. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24%-33%), with moderate certainty of evidence. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22%-44%) of cases, followed by penicillins (22%; 95% CI, 17%-28%), cephalosporins (11%; 95% CI, 6%-17%), fluoroquinolones (4%; 95% CI, 1%-7%), and macrolides (2%; 95% CI, 1%-5%). There was a statistically significant heterogeneity in the meta-analysis, which could be partially explained in the subgroup analysis by continents. The overall risk of bias was low using the Joanna Briggs Institute checklist for case series.Conclusion and RelevanceIn this systematic review and meta-analysis of all case series, antibiotics were associated with more than one-quarter of SJS/TEN cases described worldwide, and sulfonamide antibiotics remained the most important association. These findings highlight the importance of antibiotic stewardship, clinician education and awareness, and weighing the risk-benefit assessment of antibiotic choice and duration.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Toxic Epidermal Necrolysis: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Toxic Epidermal Necrolysis (condition). 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No content could be extracted for summaries or tags. The entry appears to be an 'Editors' Choice' editorial/collection notice rather than an original research article — the actual study content is not included.","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.07.012","tag_type":"warning","value":"The sulfasalazine HLA genetic findings are derived exclusively from Asian populations (Taiwan, China, Japan, Malaysia, Thailand); applicability to non-Asian populations is not established.","value_numeric":null},{"paper_doi":"10.1016/j.jaci.2026.07.012","tag_type":"warning","value":"This is an editors' summary article covering 6 distinct studies — tags and summaries reflect highlights across all studies, not a single primary investigation.","value_numeric":null}],"summaries":{"what_studied":"This editors' choice issue summarizes 6 studies covering: dupilumab in children with asthma and transient eosinophilia (VOYAGE/EXCURSION trials, ages 6–11, ≤1 year + extension); gene-microbiome interactions and childhood wheeze; miR-149 as a skin inflammation regulator; HLA genetic markers for sulfasalazine-induced SCARs; SERPING1 signal peptide variants in HAE; and tezepelumab clinical remission in severe asthma (TERESA, n=107, 52 weeks).","key_result":"$30","limitations":"This is an editors' summary of multiple studies, not a single primary paper; individual study limitations (post hoc design for dupilumab analysis, single-arm phase 4 for TERESA, Asian-only cohorts for sulfasalazine genetics) apply to each respective article and are not fully detailed here.","practice_takeaway":"In children on dupilumab for asthma, an isolated early rise in eosinophils alone is unlikely to require stopping treatment. For sulfasalazine prescribing in Asian patients, preemptive HLA screening (especially B\\*38:02, B\\*39:01, B\\*13:01) can identify those at high risk for life-threatening skin reactions before starting therapy."}},{"doi":"10.1111/all.70466","pmid":"42618976","title":"Updated EAACI Statement on Drug Hypersensitivity Skin Testing: Methodology and Non‐Irritative Concentrations","journal_title":"Allergy","journal_issn":"0105-4538","published_at":"2026-08-19T00:00:00.000Z","url":"https://doi.org/10.1111/all.70466","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-30T06:19:56.216Z","updated_at":"2026-08-30T06:19:56.216Z","tags":[{"paper_doi":"10.1111/all.70466","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Acute Generalized Exanthematous Pustulosis","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Anaphylaxis","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Drug Hypersensitivity","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Drug Reaction with Eosinophilia and Systemic Symptoms","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Maculopapular Exanthema","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Stevens-Johnson Syndrome","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"condition","value":"Toxic Epidermal Necrolysis","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Anesthetic","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Antibiotic","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Biologic","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Chemotherapy","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Contrast Media","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"modality","value":"Proton Pump Inhibitor","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"study_design","value":"Clinical Practice Guideline","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"warning","value":"Chemotherapy-specific guidance (testing within 2 weeks) differs from the general 4–6 week window; clinicians should apply the correct algorithm per drug class.","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"warning","value":"Level of evidence assigned as '3' (consensus guideline/expert panel); the paper does not report an original trial with a defined sample size, so no sample_size tag was applied.","value_numeric":null},{"paper_doi":"10.1111/all.70466","tag_type":"warning","value":"Many drug-class recommendations are 'conditional' due to sparse negative-control data, meaning specificity for those agents is not firmly established.","value_numeric":null}],"summaries":{"what_studied":"Updated EAACI guidelines standardizing skin testing methodology (prick, intradermal, patch) for immediate and non-immediate drug hypersensitivity reactions, including validated non-irritant concentrations for major drug classes and risk-stratified algorithms for drug provocation testing.","key_result":"The optimal testing window is 4–6 weeks post-reaction for immediate reactions (false negatives rise beyond 6 months); the validated intradermal test threshold is a wheal ≥ initial wheal +3 mm at 20 min after injecting exactly 0.02 mL. Risk algorithms now allow direct drug provocation for mild maculopapular exanthema, while anaphylaxis requires prior skin testing; skin tests are deemed safe and useful for DRESS/AGEP/SJS/TEN.","limitations":"Conditional recommendations are provided for many drug classes where few or no negative controls are available, limiting specificity data. Crushing tablets and diluting at 30% in petrolatum introduces significant variability in final active-ingredient concentrations.","practice_takeaway":"Test patients for immediate drug hypersensitivity 4–6 weeks post-reaction using the standardized 0.02 mL intradermal technique (wheal ≥ initial +3 mm = positive). For mild maculopapular exanthema, skin tests can be bypassed in favor of direct drug provocation, but anaphylaxis or severe cutaneous reactions (DRESS/AGEP/SJS/TEN) require skin testing first."}},{"doi":"10.1001/jamadermatol.2026.2473","pmid":"42485011","title":"Proportion of Antiepileptic Drug–Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2026-07-22T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2026.2473","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-25T13:57:38.001Z","updated_at":"2026-07-25T13:57:38.001Z","tags":[{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"condition","value":"Drug Hypersensitivity Reaction","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"condition","value":"Stevens-Johnson Syndrome","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"condition","value":"Toxic Epidermal Necrolysis","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"generic","value":"carbamazepine","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"generic","value":"lamotrigine","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"generic","value":"phenytoin","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"modality","value":"Antiepileptic Drug","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"sample_size","value":"n=4403","value_numeric":4403},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"warning","value":"Geographic subgroup 'West Asia' is a non-standard regional label; clinicians should note this may not align with all institutional geographic classifications.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"warning","value":"Pooled proportions reflect the fraction of SJS/TEN cases triggered by AEDs — not the absolute incidence rate of SJS/TEN per AED exposure — which limits direct comparison of drug-level risk.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2026.2473","tag_type":"warning","value":"The DOI and publication date (2026-07-22) are in the future relative to today (July 25, 2026) but are only days away; data extraction appears complete and consistent with a finalized publication.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis evaluated the proportion of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) cases attributable to antiepileptic drugs (AEDs), with subgroup analyses by age group (children vs. adults) and geographic region, across 50 studies (n=4,403) from MEDLINE and Embase (inception through March 17, 2026).","key_result":"AEDs accounted for 23% (95% CI, 19–26%) of SJS/TEN cases worldwide; nearly all were caused by aromatic AEDs (96%), led by carbamazepine (39%), phenytoin (19%), and lamotrigine (15%). Children had a higher proportion than adults (35% vs. 23%), and regional variation ranged from 42% in West Asia to 10% in Africa.","limitations":"- Pooled from observational studies only, limiting causal inference.\n- Significant heterogeneity across geographic regions may reduce generalizability.\n- Restricted to English-language publications, risking language bias.","practice_takeaway":"Aromatic AEDs — especially carbamazepine, phenytoin, and lamotrigine — are the dominant drug triggers of SJS/TEN; clinicians should favor nonaromatic AEDs when therapeutically equivalent options exist, particularly in children who face a disproportionately higher risk."}},{"doi":"10.1016/j.burns.2026.108143","pmid":"42407278","title":"Toxic epidermal necrolysis: Management in the ICU","journal_title":"Burns","journal_issn":"0305-4179","published_at":"2026-07-03T00:00:00.000Z","url":"https://doi.org/10.1016/j.burns.2026.108143","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-10T13:25:28.332Z","updated_at":"2026-07-10T13:25:28.332Z","tags":[{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"condition","value":"Epidermal Necrolysis","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"condition","value":"Stevens-Johnson Syndrome","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"condition","value":"Toxic Epidermal Necrolysis","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"modality","value":"Immunomodulatory Therapy","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"modality","value":"Supportive Care","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"warning","value":"Full text was not accessible — only the abstract was available. All extracted content is based solely on the abstract. Specific recommendations, cited references, and detailed protocols could not be verified.","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"warning","value":"Sample size is not applicable for a review article; no tag was assigned.","value_numeric":null},{"paper_doi":"10.1016/j.burns.2026.108143","tag_type":"warning","value":"Sex of study population is not reported in the abstract.","value_numeric":null}],"summaries":{"what_studied":"This review examines ICU management of epidermal necrolysis (EN) — including SJS, TEN, and SJS-TEN overlap — during the acute phase, covering supportive care and pharmacological interventions in specialized (including burn) centers.","key_result":"Supportive care remains the cornerstone of management; no immunomodulatory treatment has been shown to halt skin detachment or reduce mortality. Average mortality is 15–20%, with respiratory and septic complications as the main prognostic drivers.","limitations":"Only the abstract was available for extraction — full text was inaccessible. Specific recommendations, evidence grades, and cited studies could not be assessed. As a narrative review, it may reflect expert opinion rather than systematic evidence synthesis.","practice_takeaway":"Stop any suspected causative drug as early as possible and transfer patients to a specialized multidisciplinary center (dermatology-led, burn center if needed). No immunomodulatory agent has proven benefit, so high-quality supportive care is the priority."}},{"doi":"10.1001/jamadermatol.2025.4345","pmid":"41222950","title":"Recovering From Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2025-11-12T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2025.4345","source_score":70,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-11-16","doi":"10.1001/jamadermatol.2025.4345","days":"30","issn":"2168-6068","rank":"6","field":"Clinical Medicine","score":"70","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2025.4345","title":"Recovering From Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.","journal":"JAMA 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Immunology, Vanderbilt University Medical Center, Nashville, Tennessee"}]},{"given":"Kemberlee R.","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Department of Psychology, Vanderbilt University, Nashville, Tennessee"}]},{"given":"Benjamin H.","family":"Kaffenberger","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus"}]},{"given":"David G.","family":"Schlundt","sequence":"additional","affiliation":[{"name":"Department of Psychology, Vanderbilt University, Nashville, Tennessee"}]},{"given":"Elizabeth J.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Australia"}]},{"given":null,"family":null,"sequence":"additional","affiliation":[]},{"given":"Roni","family":"Dodiuk-Gad","sequence":"additional","affiliation":[{"name":"for the SJS Survivor Study"}]},{"given":"Aaron","family":"Drucker","sequence":"additional","affiliation":[{"name":"for the SJS Survivor Study"}]},{"given":"Elizabeth","family":"Ergen","sequence":"additional","affiliation":[{"name":"for the SJS Survivor Study"}]},{"given":"Rama","family":"Gangula","sequence":"additional","affiliation":[{"name":"for the SJS Survivor Study"}]},{"given":"Michelle","family":"Goh","sequence":"additional","affiliation":[{"name":"for the SJS Survivor Study"}]},{"given":"Dana","family":"King","sequence":"additional","affiliation":[{"name":"for the SJS Survivor Study"}]},{"given":"Rebecca","family":"Lee","sequence":"additional","affiliation":[{"name":"for the SJS Survivor Study"}]},{"given":"Kelby","family":"Mahan","sequence":"additional","affiliation":[{"name":"for the SJS Survivor 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HLA-B*58:01 (OR 28.0, 95% CI 8.6-100.6) and HLA-A*34:02 (OR 20.6, 95% CI 3.3-131.1); no class II allele met Bonferroni-corrected significance. HLA-B*58:01 was absent in more than one-third of cases, indicating incomplete sensitivity.","limitations":"Very small case sample (n=16) with wide confidence intervals. Controls from a single biobank used imputed HLA typing, which may reduce allele-calling accuracy.","practice_takeaway":"HLA-B*58:01 remains a strong risk marker for allopurinol-induced SCAR in US patients, but testing alone will miss many at-risk patients. HLA-A*34:02 emerged as a second independent risk allele and warrants replication before informing routine screening."}},{"doi":"10.1016/j.burns.2023.06.016","pmid":"37730480","title":"The seven-fold rise in incidence of Stevens-Johnson syndrome & toxic epidermal necrolysis: Associations with COVID-19 and the vaccine","journal_title":"Burns","journal_issn":"0305-4179","published_at":"2023-09-21T00:00:00.000Z","url":"https://doi.org/10.1016/j.burns.2023.06.016","source_score":1055,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2024-01-01","doi":"10.1016/j.burns.2023.06.016","days":"30","issn":"0305-4179","rank":"1","field":"Clinical Medicine","score":"1055","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1016/j.burns.2023.06.016","title":"The seven-fold rise in incidence of Stevens-Johnson syndrome & toxic epidermal necrolysis: Associations with COVID-19 and the vaccine.","journal":"Burns : journal of the International Society for Burn Injuries","methods":"","results":"","abstract":"Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a rare, potentially life threatening mucocutaneous hypersensitivity reaction resulting in desquamation of the skin and mucosa. These patients are managed on burns units due to the widespread desquamation. We report the largest case series of participants developing SJS/TEN in the setting of recent COVID infection or vaccination. We found a seven-fold increase in SJS/TEN since the COVID pandemic. This increase correlates with an increase in COVID infections and vaccination rates. We explore the immunopathological relationships between COVID and SJS/TEN and propose theories for possible associations.","keywords":["COVID-19","Stevens-Johnson syndrome","Toxic epidermal necrolysis"],"pubmed_id":"37730480","conclusions":"","publication_date":"2023-09-21T00:00:00"},"crossref":{"DOI":"10.1016/j.burns.2023.06.016","URL":"https://doi.org/10.1016/j.burns.2023.06.016","ISSN":["0305-4179"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0305417923001286?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0305417923001286?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":"87-92","type":"journal-article","issue":"1","score":1,"title":["The seven-fold rise in incidence of Stevens-Johnson syndrome & toxic epidermal necrolysis: Associations with COVID-19 and the 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rates.","practice_takeaway":"Be alert to SJS/TEN as a potential post-COVID infection or post-vaccination event; take a recent COVID infection and vaccination history when evaluating suspected SJS/TEN, recognizing this is an association signal rather than proof of causality."}},{"doi":"10.1001/jamadermatol.2022.6378","pmid":"36790777","title":"Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2023-02-16T00:00:00.000Z","url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9932945","source_score":62,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2023-03-05","doi":"10.1001/jamadermatol.2022.6378","days":"30","issn":"2168-6068","rank":"5","field":"Clinical Medicine","score":"62","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2022.6378","title":"Worldwide Prevalence 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The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24%-33%), with moderate certainty of evidence. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22%-44%) of cases, followed by penicillins (22%; 95% CI, 17%-28%), cephalosporins (11%; 95% CI, 6%-17%), fluoroquinolones (4%; 95% CI, 1%-7%), and macrolides (2%; 95% CI, 1%-5%). There was a statistically significant heterogeneity in the meta-analysis, which could be partially explained in the subgroup analysis by continents. 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Necrolysis","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2022.6378","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2022.6378","tag_type":"modality","value":"Antibiotic","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2022.6378","tag_type":"sample_size","value":"n=2917","value_numeric":2917},{"paper_doi":"10.1001/jamadermatol.2022.6378","tag_type":"study_design","value":"Systematic Review and Meta-analysis","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2022.6378","tag_type":"warning","value":"Design is a systematic review and meta-analysis of case series; findings are proportions among cases, not population incidence.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2022.6378","tag_type":"warning","value":"High heterogeneity across studies; some variation was explained by continent.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2022.6378","tag_type":"warning","value":"Several studies lacked formal drug causality assessment, which may influence pooled estimates.","value_numeric":null}],"summaries":{"what_studied":"A global systematic review and meta-analysis of case series assessed how often antibiotics are implicated in SJS/TEN, searching MEDLINE and Embase through February 22, 2022; 38 studies with 2,917 patients contributed patient-level data on single antibiotics.","key_result":"Across 38 studies (n=2,917), antibiotics were implicated in 28% of SJS/TEN cases (95% CI, 24%-33%). Among antibiotic-associated cases, sulfonamides accounted for 32% (95% CI, 22%-44%), penicillins 22% (17%-28%), cephalosporins 11% (6%-17%), fluoroquinolones 4% (1%-7%), and macrolides 2% (1%-5%); heterogeneity was statistically significant and varied by continent.","limitations":"Substantial between-study heterogeneity was present; many reports lacked explicit drug causality assessment (sensitivity analysis with defined causality: 27% [95% CI, 17%-39%]); all included data were case series, estimating proportions among cases rather than population incidence.","practice_takeaway":"About one-quarter of SJS/TEN cases are antibiotic-associated worldwide, with sulfonamides leading and penicillins and cephalosporins next. When prescribing antibiotics, weigh these risks and reinforce stewardship, education, and careful duration choices."}}],"initialOffset":8,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Toxic Epidermal Necrolysis"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Toxic Epidermal Necrolysis"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Toxic Epidermal Necrolysis"}}}]]

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