Multiple Drug Intolerance Syndrome: An Underreported Distinct Clinical Entity.

AIM: Multiple drug intolerance syndrome (MDIS) is a unique clinical entity distinct from other drug hypersensitivity syndromes. The aim of this review was to critically appraise the various aspects of MDIS. METHODS: A review was conducted to search for the causes, mechanism, clinical features, and management of MDIS. RESULTS: The most common cause of MDIS is antibiotics followed by non-steroidal antiinflammatory drugs (NSAIDs). Although some non-specific immunological mechanisms are involved, the immunological tests for MDIS are negative. Rashes, gastrointestinal reflux, headache, cough, muscle ache, fever, dermatitis, hypertension, and psychiatric symptoms are the usual manifestations. Treatment is mostly symptomatic with the withdrawal of the offending drug. Drug rechallenges and desensitization may be required for the management of this syndrome. CONCLUSION: MDIS occurs by a nonimmune mechanism which requires a prompt withdrawal of the offending drug(s), and in some cases may require drug re-challenge and desensitization.

Agreement Among Different Scales for Causality Assessment in Drug-Induced Liver Injury.

BACKGROUND AND OBJECTIVE: The causality assessment of drug-induced liver injury (DILI) remains a challenge and eagerly awaits the development of reliable hepatotoxicity biomarkers. None of the different available algorithms used for the causality assessment of DILI has been universally accepted as the gold standard. This study was conducted to examine the agreement among different causality assessment scales in reporting DILI. METHODS: The World Health Organization-Uppsala Monitoring Center (WHO-UMC), Naranjo, Roussel Uclaf Causality Assessment Method (RUCAM), Maria & Victorino (M & V) and Digestive Disease Week-Japan (DDW-J) assessment scales were used to compare the causalities in all the reported cases of DILI in our adverse drug reaction (ADR) monitoring centre from January 2014 to June 2017. The probability of the causality assessment was classified as 'definite', 'probable', 'possible' and 'unlikely'. The agreement obtained among the causality assessments was analysed using the weighted kappa (κ w) test. RESULTS: A total of 33 cases of DILI were included in our analyses. Anti-tubercular therapy (ATT) and methotrexate were the drugs that most commonly caused DILI. The overall agreement among the different scales was poor. The best agreement was found between RUCAM and DDW-J scales (κ w: 0.685). CONCLUSION: There were discrepancies among the different causality scales in assessing DILI. This might be due to the different definitions of causality criteria and subjective variability during assessment. A personalised assessment scale incorporating the latest information on specific risk factors and evidence-based criteria for DILI is warranted.