Evaluation of risk factors for recurrence  of cutaneous adverse reactions due to anti-seizure medications in children:  A retrospective study

Çağatay Günay; Gamze Sarıkaya Uzan; Suna Asilsoy; Nevin Uzuner; Özge Kangallı; Semra Hız Kurul; Uluç Yiş

doi:10.18502/cjn.v22i4.14524

Çağatay Günay Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Gamze Sarıkaya Uzan Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Suna Asilsoy Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Nevin Uzuner Department of Pediatric Immunology and Allergy, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Özge Kangallı Department of Pediatric Immunology and Allergy, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Semra Hız Kurul Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Uluç Yiş Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey

DOI: https://doi.org/10.18502/cjn.v22i4.14524

Keywords: Drug Eruptions; Rash; Antiepileptic Drug; Epilepsy; Carbamazepine

Abstract

Background: Cutaneous adverse reactions (CARs) are one of the most important reasons for anti-seizure medication (ASM) discontinuation in epilepsy. However, such discontinuations can cause an increase in seizures. This study investigates the risk factors for ASM-related rash recurrence in children.

Methods: This retrospective case-control study consisted of the patient group with a single rash due to ASMs (group 1), the patient group with rash recurrence (group 2), and the control group. While the demographic and clinical features of group 1 and the control group were compared in terms of a single rash, group 1 and group 2 were compared for rash recurrence.

Results: Group 1, group 2, and control group consisted of 112, 33, and 166 patients, respectively. Female gender was a risk factor for a single rash (P < 0.001) but not for recurrence (P = 0.439). Presence of atopic disease [odds ratio (OR): 9.5, 95% confidence interval (CI): 3.8-23.1, P < 0.001], family history of drug allergy (OR: 26.3, 95% CI: 9.6-72.1, P < 0.001), and polytherapy (OR: 23.5, 95% CI: 8.7-62.9, P < 0.001) were risk factors for rash recurrence. Aromatic nature of both the ASMs associated with the first rash
(OR: 14.4, 95% CI: 3.2-63.2, P < 0.001) and rash recurrence (OR: 11.3, 95% CI: 4.6-27.5, P < 0.001) were determined as risk factors separately.

Conclusion: Careful use of aromatic drugs may prevent recurrence of ASM-related CAR in children, particularly in cases of personal history of allergic disease and family history of drug allergy.