Cutaneous drug eruptions (CDE) cause significant morbidity and mortality and impact on future medication choices. Healthcare providers’ knowledge and assessment of severe CDE has not been adequately studied.
Objectives: To evaluate healthcare providers’ understanding on the principles of adverse drug reactions (ADR) contributing to CDE and to identify knowledge gaps.
A survey with case scenarios to test various ADR principles (syndrome recognition, immediate vs. delayed reactions, severe cutaneous adverse reactions [SCAR], diagnostics, causality evaluation, cross-reactivity and risk communication) was conducted amongst doctors and pharmacists via online or face-to-face sessions. Self-rated clinical experience and comfort levels in managing severe CDE were also measured.
Ninety-nine participants completed the survey [74(74.7%) doctors and 25(25.3%) pharmacists], including 20(27.1%) dermatologists. Thirty-eight of seventy-four (51.4%) were senior doctors and five were senior pharmacists. IgE-mediated anaphylaxis was correctly identified by 91.9% but recognition of non-IgE-mediated immediate hypersensitivity reactions was limited. Accurate knowledge of beta-lactam cross-reactivity ranged from 44.4% to 79.8%, depending on scenario. Only 44.4% recognised high predictive value of negative penicillin skin tests. Lack of cross-reactivity involving sulfonilamides was correctly identified by 66.3%. However, drug causality attribution in Stevens-Johnsons Syndrome (SJS) and drug rash with eosinophilia and systemic symptoms (DRESS) was accurate in only 43.4% and 61.6% respectively. Over half the respondents (57.6%) were unfamiliar with principles of desensitisation. Compared to pharmacists, doctors had more accurate knowledge on penicillin skin tests and diagnostics of SJS (p=0.005 and 0.03 respectively). Self-rated clinical experience (average number of CDE patients/year) and comfort levels correlated with increased accuracy of certain knowledge parameters.
Recognition of severe CDE is essential to ensure timely patient care, yet healthcare providers have limited knowledge of ADR principles. There is an opportunity and urgency for further development of educational resources targeting identification and treatment of these life-threatening conditions.