The assessment of severe cutaneous adverse drug reactions
Bibliographic record
Abstract
The assessment of severe cutaneous adverse drug reactions SUMMARY Severe cutaneous adverse drug reactions include Stevens-Johnson syndrome, toxic epidermal necrolysis and acute generalised exanthematous pustulosis.These eruptions are a type of delayed hypersensitivity reaction and can be life-threatening.The assessment of a severe cutaneous drug reaction requires a detailed clinical history and examination to identify the culprit drug and evaluate the allergy.Allopurinol, antibiotics and anticonvulsants are often implicated.Patch testing and delayed intradermal testing can assist in determining if the reaction was allergic, however there is limited evidence about the sensitivity and specificity of skin testing in severe cutaneous adverse drug reactions.If the testing is non-conclusive or negative, it is recommended to avoid the suspected culprit drug and any structurally similar drug in future.Any decision to reintroduce a drug should be made after considering the harm-benefit ratio.Caution is also needed if considering a possibly cross-reactive drug in a patient with a history of severe cutaneous adverse drug reactions.can reach 30-50%.5 The distinction between Stevens-Johnson syndrome and toxic epidermal necrolysis is determined by the affected body surface area: • 1-10% for Stevens-Johnson syndrome • 10-30% for Stevens-Johnson syndrome or toxic epidermal necrolysis overlap • >30% for toxic epidermal necrolysis.3Several clinical manifestations should raise the suspicion of a severe cutaneous adverse reaction.These include dark-purple skin infiltration, facial swelling, skin peeling and blistering, mucosal involvement, adenopathy, fever and haematological and biochemical laboratory abnormalities.A presence of any of these should warrant urgent hospital referral.An adverse event that involves a drug should be reported to the Australian Therapeutic Goods Administration. Other drug eruptionsThe most common benign cutaneous reaction to drugs is the maculopapular exanthema or morbilliform drug eruption.This is characterised by maculopapular red skin lesions that can become widespread and confluent.There may be pruritus and mild eosinophilia.3 The fixed-drug eruption is a reaction characterised by well-defined, red-dark, burning or itchy lesions.These lesions may reappear in the same areas on
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".