Abstract
Purpose :
Controversy exists as to the exact autoimmune pathophysiology of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Because atopy is a common immune disorder, we conducted a retrospective, observational chart review to determine the incidence of components of the atopic triad (AT; atopic dermatitis, asthma, or allergic rhinitis) in patients with history of SJS/TEN and then examined if a difference exists in acute ocular outcomes in SJS/TEN patients who have AT vs those who don't have AT.
Methods :
Patients with history of any of the AT constituents were identified using the Research Patient Data Registry of Mass General Brigham (MGB). A combined search was then run to identify all SJS/TEN patients within this group. Diagnosis of SJS/TEN was confirmed by biopsy report or exam by dermatology or burn service as documented in the medical record. Chart review was done to confirm clinical diagnosis of the atopic conditions and that they were documented as occurring prior to the diagnosis of SJS. The primary outcome was the worst acute ocular severity (AOS) score reached during the acute SJS hospitalization. All statistics were performed in R version 4.0.2. Means with standard deviations are presented for ordinal variables.
Results :
Twenty-three unique patients with atopic conditions and confirmed history of SJS/TEN were included. Four patients had a history of atopic dermatitis, 10 of allergic rhinitis, and 18 of asthma.* One hundred seventy seven SJS/TEN patients without history of any atopic conditions were included as controls. One hundred fifty-five of these patients had AOS scores available for analysis. Worse mean AOS score was seen in those with any component of the AT vs controls (p=0.01542). The prevalence of atopy in this SJS population exceeded that in the general MGB population (P < .0001).
*Total number of unique patients is fewer than the sum of the groups as several patients had more than one atopic condition.
Conclusions :
In this study, there was worse acute SJS-induced ocular disease in those with a history of atopy compared to those without. A history of atopy may exist at a higher-than-expected rate in SJS/TEN. The underlying mechanisms to explain these associations are not known. Plausible contributory factors may include baseline immune dysregulation, increased inflammatory markers, and an IgE mediated component of disease onset or exacerbation in SJS/TEN.
This is a 2021 ARVO Annual Meeting abstract.