Stevens-Johnson syndrome and toxic epidermal necrolysis: A cross-sectional analysis of patients in an integrated allergy repository of a large health care system

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, carrying an associated mortality ranging from 5% to 40%.1,2 Known risk factors for SJS/TEN include HIV infection, female gender, and certain HLA genotypes.1,3,4 Various medications have been described to cause SJS/TEN, with strongest associations with allopurinol, antiepileptics, nonsteroidal antiinflammatory drugs (NSAIDs), sulfa-containing antibiotics, β-lactam antibiotics, quinolones, and nevirapine.3-6 SJS/TEN is rare, affecting about 2 persons per million per year, with SJS 3 times more common than TEN.3,7 However, much of the epidemiologic data on SJS/TEN are limited to national and international reporting networks or cohorts after specialist referral or hospitalization.2,5,6 The largest US epidemiologic data identified cases on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification codes.8,9 We aimed to determine the prevalence of SJS/TEN among patients in a large health system by searching an electronic allergy repository and to evaluate demographic, allergy, and allergen characteristics of this population. Drug type No. (%) Antibiotic 526 (58.4) Sulfonamide 283 (31.4) Penicillins[low *] 91 (10.1) Cephalosporin 42 (4.7) Macrolides 23 (2.6) Quinolone 20 (2.2) Vancomycin 20 (2.2) Tetracycline 18 (2.0) Clindamycin 13 (1.4) Metronidazole 4 (0.4) Aminoglycosides 3 (0.3) Trimethoprim 3 (0.3) Nitrofurantoin 2 (0.2) Carbapenem 1 (0.1) Other antibiotic[dagger] 3 (0.3) Antiepileptic 175 (19.4) Lamotrigine 55 (6.1) Phenytoin 40 (4.4) Carbamezepine 30 (3.3) Phenobarbital 20 (2.2) Oxcarbazepine 8 (0.9) Gabapentin 4 (0.4) Topiramate 4 (0.4) Divalproex 3 (0.3) Other or unknown antiepileptic[double dagger] 11 (1.2) NSAIDs 55 (6.1) Ibuprofen 10 (1.1) Naproxen 7 (0.8) Aspirin 4 (0.4) Sulindac 3 (0.3) Meloxicam 2 (0.2) Piroxicam 2 (0.2) Indomethacin 2 (0.2) Other§ 25 (2.8) Cardiovascular medications 22 (2.4) Sulfa-containing diuretic|| 5 (0.6) Beta blockers¶ 5 (0.6) ACE Inhibitors# 4 (0.4) Calcium channel blockers[low *][low *] 3 (0.3) Antiarrythmics[dagger][dagger] 2 (0.2) Statins (atorvastatin) 2 (0.2) Angiotensin-receptor blockers (valsartan) 1 (0.1) Uricosuric 20 (2.2) Allopurinol 19 (2.1) Probenicid 1 (0.1) Antiretrovirals 15 (1.7) Nevirapine 6 (0.7) Efavirenz 3 (0.3) Other antiretrovirals[double dagger][double dagger] 6 (0.7) Antidepressants 14 (1.6) Buproprion 6 (0.7) Other antidepressants§§ 8 (0.9) Other neuro/