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1.
Ned Tijdschr Geneeskd ; 1652021 02 05.
Artigo em Holandês | MEDLINE | ID: mdl-33651507

RESUMO

In 2021 many people in the Netherlands will be vaccinated against COVID-19. The mass vaccination and the new types of vaccines trigger questions about the safety of these vaccines. In this paper we discuss: (1) what reactions are expected from COVID-19 vaccines, (2) what precautions are needed when vaccinating people, and (3) how to act when allergic reactions occur. The COVID-19 vaccines include the first vaccines produced with the mRNA platform. The most frequent adverse reactions are comparable with other vaccines. Allergic reactions to COVID-19 vaccines are rare but can occur. These reactions may be related to excipients in the vaccines, like polyethylene glycol. In case of a possible allergic reaction, a doctor, in consultation with an allergist, can investigate whether vaccination is safe in the future and whether precautions are necessary. Allergic reactions to vaccine components must be recorded completely and unambiguously in the patient file.


Assuntos
Hipersensibilidade a Drogas , Medição de Risco/métodos , Vacinação , /epidemiologia , /efeitos adversos , /farmacologia , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/prevenção & controle , Hipersensibilidade a Drogas/terapia , Humanos , Países Baixos/epidemiologia , Risco Ajustado , Vacinação/métodos , Vacinação/normas
2.
Curr Allergy Asthma Rep ; 21(2): 8, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33560451

RESUMO

PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19. RECENT FINDINGS: There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care.


Assuntos
Asma/terapia , Hipersensibilidade Alimentar/terapia , Controle de Infecções/métodos , Rinite Alérgica/terapia , Telemedicina , Asma/imunologia , Produtos Biológicos , Dermatite Alérgica de Contato/imunologia , Dermatite Alérgica de Contato/terapia , Dermatite Atópica/imunologia , Dermatite Atópica/terapia , Dessensibilização Imunológica , Gerenciamento Clínico , Surtos de Doenças , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Alimentar/imunologia , Pessoal de Saúde , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Rinite Alérgica/imunologia
4.
Clin Dermatol ; 38(6): 648-659, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33341199

RESUMO

Neutrophilic drug reactions are unique eruptions that can affect hospitalized patients and share a common pathophysiology with neutrophils as the key mediators of inflammation. They range in clinical presentation from papules and plaques to bullae and erosions to pustules. Although there is some overlap in presentation, each has distinguishing features that aid the clinician in differentiation from one another and from other drug hypersensitivity reactions. Much of the data on these reactions are from case reports and series or retrospective review studies. There are limited prospective observational studies dedicated to these adverse drug reactions. We review the more common and life-threatening neutrophilic drug reactions, their proposed mechanism of action, and their management.


Assuntos
Erupção por Droga/etiologia , Hipersensibilidade a Drogas/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neutrófilos , Preparações Farmacêuticas , Erupção por Droga/diagnóstico , Erupção por Droga/patologia , Erupção por Droga/terapia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/patologia , Hipersensibilidade a Drogas/terapia , Exantema , Feminino , Halogênios/efeitos adversos , Hidradenite , Humanos , Imunoglobulina A , Masculino , Neutrófilos/imunologia , Paniculite , Pioderma Gangrenoso , Dermatopatias Vesiculobolhosas , Síndrome de Sweet
7.
Ann Allergy Asthma Immunol ; 124(6): 566-572, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32302769

RESUMO

OBJECTIVE: To review novel concepts in drug hypersensitivity and the management of immediate hypersensitivity reactions. DATA SOURCES: English language literature on MEDLINE and Embase surrounding drug hypersensitivity and desensitization. STUDY SELECTIONS: References were selected based on relevance, date of publication, and originality. RESULTS: There are numerous citations looking at categorizing drug reactions, pathogenesis, biomarkers, and desensitization. Current understanding supports the use of a phenotype-endotype-biomarker model for categorizing immediate hypersensitivity reactions. Drug desensitization is a powerful therapeutic strategy that enables temporary induction of tolerance to medications that triggered immediate reactions. CONCLUSION: Immediate hypersensitivity reactions are diverse in presentation and pathogenesis. Drug desensitization is an effective intervention with sufficient evidence to support its more widespread availability.


Assuntos
Biomarcadores , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Fenótipo , Basófilos , Dessensibilização Imunológica , Gerenciamento Clínico , Suscetibilidade a Doenças , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/terapia , Predisposição Genética para Doença , Custos de Cuidados de Saúde , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/etiologia , Imunoglobulina E , Índice de Gravidade de Doença , Testes Cutâneos
8.
J Oncol Pharm Pract ; 26(5): 1282-1284, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32050851

RESUMO

Monoclonal antibodies were introduced to clinical practice in 1980s and play a vital role in a variety of diseases and clinical interventions including cancer, inflammatory disease, and ophthalmologic disease. There is a lack of substantial research or evidence on the effect of occupational exposure on staff, leading many staff to have significant concerns about what is a safe level of exposure, especially given their increasing availability and use. This report describes a case in which a nurse became sensitised to monoclonal antibodies as a result of preparing and administering them in a clinical area, and the subsequent actions taken in response to the incident to reduce the risk to staff.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Enfermeiras e Enfermeiros/normas , Exposição Ocupacional/efeitos adversos , Local de Trabalho , Anticorpos Monoclonais/imunologia , Antineoplásicos Imunológicos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Feminino , Humanos , Oncologia/normas , Local de Trabalho/normas , Adulto Jovem
9.
Ann Allergy Asthma Immunol ; 124(6): 589-593, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32087343

RESUMO

BACKGROUND: Hypersensitivity reactions (HSRs) to tetracyclines and the related compound, tigecycline, can limit the use of these medications and compromise optimal patient care. Despite this, there is little discussion in the literature describing the presentation of these reactions or guiding clinicians on the management of these reactions in adult and pediatric patients. OBJECTIVE: To describe the clinical features, optimal diagnostic approach, and management of HSRs to tetracyclines. METHODS: Patients with reactions to tetracyclines at our institution from 2011 to 2019 were identified by retrospective chart review. Skin testing protocols were designed for each antibiotic. Graded challenge and desensitization procedures were devised based on medical history, skin testing results when available, and need for readministration. RESULTS: The HSRs to tetracyclines, their workup, and management are described for 10 patients, aged 7 to 68 years. Our skin testing protocols for doxycycline, minocycline, and tigecycline described herein had good negative predictive value. When skin testing was negative and the initial reaction was not severe, graded challenge to the culprit drug was performed. Using the included procedures, 3 patients were desensitized to oral doxycycline, 3 to oral minocycline, and 2 to intravenous tigecycline. All the desensitizations were successful. CONCLUSION: Once identified, HSRs to tetracyclines can be further evaluated with skin testing and graded challenge and managed in appropriate cases with desensitization. These procedures can facilitate first-line therapy for patients who require tetracyclines but developed hypersensitivity reactions.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/imunologia , Tetraciclinas/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Adulto Jovem
10.
Med Clin North Am ; 104(1): 109-128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757230

RESUMO

Drug hypersensitivity reactions (DHRs) may be classified based on timing (immediate vs delayed), mechanisms, and pattern of clinical manifestations. Management may include selection of alternative, non-cross reactive agents, drug allergy testing, graded challenge and/or desensitization. Immediate skin testing only identifies risk for immediate-type allergic DHR and has a negative predictive value for only a limited number of drugs (eg, penicillin). Desensitization induces a temporary state of tolerance that is maintained only so long as the drug is continued. This article discusses special considerations about antibiotics, angiotensin-converting enzyme inhibitors, anesthetic agents, aspirin and nonsteroidal antiinflammatory drugs, radiocontrast media, and chemotherapeutic agents.


Assuntos
Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Testes Cutâneos/estatística & dados numéricos , Anestésicos/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Antibacterianos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Humanos , Valor Preditivo dos Testes
12.
Clin Exp Rheumatol ; 38(3): 552-557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31820716

RESUMO

OBJECTIVES: Biologic drugs (BD) have been game-changers in rheumatic diseases; however, severe hypersensitivity reactions concerning anaphylaxis may limit their use. Desensitisation is a crucial option that is safe and effective to maintain patients on the preferred drug. Herein we report 84 Rapid Drug Desensitisation (RDD) procedures with rituximab and tocilizumab in children with rheumatic diseases. METHODS: The study was conducted as a retrospective chart review of patients who received tocilizumab or rituximab therapy between January 2010 and December 2018. The results of RDD with tocilizumab and rituximab were documented. RESULTS: The study group consisted of 53 patients (11.6±4.5 years, 67.9% female) with rheumatic disease who had used tocilizumab (64.1%, 1007 infusions) or rituximab (35.8%, 73 infusions). Five patients (14.7%) had experienced anaphylaxis with tocilizumab and two patients (10.5%) with rituximab. Anaphylaxis was grade II in four cases whereas it was grade III in the remaining three children. Skin testing with the culprit BD performed in five children yielded positive results. We performed 65 RDDs with tocilizumab in 3 patients and 19 RDDs with rituximab in two patients. No reactions were recorded in 97.6% of the procedures. We observed one anaphylaxis during the 5th RDD of tocilizumab. After modifying the protocol, this patient continued tocilizumab RDD uneventfully. CONCLUSIONS: RDD is a groundbreaking innovation which ensures giving the full target doses while protecting the patient against severe hypersensitivity reactions (HSRs) and anaphylaxis. As BD use increases in childhood, management of HSRs to BD will become more complicated, necessitating an increased need for RDD in clinical practice.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Dessensibilização Imunológica , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Imediata/terapia , Rituximab/efeitos adversos , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
13.
Artigo em Inglês | MEDLINE | ID: mdl-31530511

RESUMO

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options. Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for provocation testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective was to draft an easy-toread, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated.


Assuntos
Alérgenos/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Testes de Provocação Nasal/métodos , Alergia e Imunologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/administração & dosagem , Hipersensibilidade a Drogas/terapia , Prova Pericial , Humanos , Guias de Prática Clínica como Assunto , Espanha
14.
Pract Neurol ; 20(1): 75-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31273082

RESUMO

Recombinant tissue plasminogen activator (rtPA) is currently the only approved thrombolytic agent for treating acute ischaemic stroke that is widely used in clinical practice. However, it may cause haemorrhage and hypersensitivity reactions. Orolingual angioedema is an infrequent, usually mild but potentially life threatening, hypersensitivity reaction to rtPA. Our understanding of the basic biology of angioedema has increased in recent years. There is growing evidence that rtPA-induced orolingual angioedema is driven mainly by bradykinin generation rather than it being an anaphylactic response. Monitoring is important because orolingual angioedema may evolve and compromise airways and a small number do have angioedema as part of systemic anaphylaxis. There are no published guidelines for treating rtPA-induced orolingual angioedema, although some evidence suggests that those refractory to standard antianaphylactic agents may resolve with bradykinin B2 receptor antagonists. It is important that responses to orolingual angioedema are proportionate and that patients are closely monitored.


Assuntos
Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Proteínas Recombinantes/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Angioedema/induzido quimicamente , Angioedema/diagnóstico , Angioedema/terapia , Hipersensibilidade a Drogas/etiologia , Humanos
15.
J Oncol Pharm Pract ; 26(5): 1244-1247, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31822201

RESUMO

INTRODUCTION: Pomalidomide is an immunomodulating agent that is used to treat relapsed and/or refractory multiple myeloma. Although the incidence of hypersensitivity with pomalidomide is not well documented, the most common type of hypersensitivity involves a cutaneous reaction. Previous reports have successfully utilized a desensitization protocol in patients who developed hypersensitivity to pomalidomide. Here we describe a case of a patient who developed urticaria on pomalidomide and successfully underwent a desensitization using the previously reported method in a case report. CASE REPORT: A 68-year-old woman with relapsed multiple myeloma and no known drug allergies developed urticaria a day after taking the first dose of pomalidomide. MANAGEMENT AND OUTCOME: The patient underwent a 10-step desensitization process in the medical intensive care unit without any reported adverse events. The following day in the medical intensive care unit, the patient was able to tolerate a full dose of pomalidomide with no further reactions and was discharged with instructions to take a full dose of pomalidomide daily for 21 days out of a 28-day cycle. The patient was followed up in the outpatient clinic and noted no further reactions from pomalidomide at the three-month visit. DISCUSSION: The 10-step desensitization protocol with pomalidomide was well tolerated in the patient with hypersensitivity to pomalidomide. Whether this approach would work in patients with more severe reactions such as anaphylaxis and angioedema is still unknown.


Assuntos
Dessensibilização Imunológica/métodos , Fatores Imunológicos/efeitos adversos , Talidomida/análogos & derivados , Urticária/induzido quimicamente , Urticária/diagnóstico , Idoso , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Feminino , Humanos , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/imunologia , Talidomida/efeitos adversos , Urticária/terapia
16.
Artigo em Inglês | IBECS | ID: ibc-194102

RESUMO

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options. Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for provocation testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective was to draft an easy-toread, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated


Los antiinflamatorios no esteroideos (AINE) son medicamentos ampliamente utilizados a nivel mundial y frecuentemente implicados en reacciones de hipersensibilidad que pueden comprender desde reacciones locales y/o leves a reacciones sistémicas y graves. La complejidad del diagnóstico ante la falta de pruebas cutáneas o de laboratorio estandarizadas y/o validadas, hace que en muchos casos debamos realizar pruebas de provocación de alto riesgo. Por ello, es necesario un exhaustivo estudio de estos pacientes en los que tienen gran importancia el correcto diagnóstico y la búsqueda de procedimientos más seguros ante pacientes con reacciones graves, así como también la búsqueda de opciones alternativas de tratamientos antiinflamatorios. Actualmente existen diversas guías y protocolos de actuación que describen el manejo de la hipersensibilidad a los AINE aunque con importante variabilidad entre diferentes países. Desde los distintos comités de Asma, Rinoconjuntivitis y Alergia a Fármacos de la Sociedad Española de Alergología e Inmunología Clínica (SEAIC) proponemos un documento de posicionamiento sobre las opciones en las pruebas de provocación con aspirina/ AINE. Este documento es el resultado de una revisión exhaustiva de la evidencia actual, basada en publicaciones recientes sobre el diagnóstico de pacientes con hipersensibilidad a AINE, y de la discusión consensuada de un grupo de expertos de la SEAIC. El objetivo fundamental ha sido elaborar una guía práctica de fácil lectura dirigida a profesionales sanitarios de atención especializada implicados en el estudio y manejo de pacientes con sospecha de hipersensibilidad a AINE. Además, se ha realizado una actualización sobre las indicaciones, contraindicaciones y procedimientos de las pruebas de provocación oral, bronquial y nasal con aspirina/AINE


Assuntos
Humanos , Alérgenos/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Testes de Provocação Nasal/métodos , Alergia e Imunologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/administração & dosagem , Hipersensibilidade a Drogas/terapia , Prova Pericial , Guias de Prática Clínica como Assunto , Espanha
19.
Arch Argent Pediatr ; 117(1): S24-S36, 2019 02.
Artigo em Espanhol | MEDLINE | ID: mdl-31833344

RESUMO

The Allergic Reactions to Betalactam Antibiotics are adverse events that cannot be explained by their pharmacological action, but mediated by an immunological mechanism. They are the most frequent cause of drug allergy in the world. Betalactam antibiotics include penicillins, cephalosporins, carbapenems, monobactams, cefems (moxalactam, cefoxitin), and clavulanic acid. They can produce immediate, accelerated or delayed allergic reactions. Its diagnostic methodology is complex and it is carried out by well-defined stages. Its timely diagnosis is very important due to the risk involved and the associated costs that demand the alternative use of other antibiotics that supplant them.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , beta-Lactamas/efeitos adversos , Antibacterianos/imunologia , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/terapia , Humanos , beta-Lactamas/imunologia
20.
Seizure ; 72: 61-70, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31708349

RESUMO

Adverse cutaneous reactions caused by mostly aromatic antiepileptic drugs (AED) affect 50.000 people a year in the United Kingdom (UK; incidence 75.7/100.000). Optimal management of these cases is often difficult, as the patient may report symptoms to a general practitioner, attend Accident & Emergency or inform a specialist over the telephone or via email. When clinical assessment is limited it is thought safest to withdraw offending medication and inform the patient of a new drug allergy. This may unjustifiably restrict future treatment choices, and increase cost. Most frequent offenders are aromatic AEDs: carbamazepine, oxcarbazepine, eslicarbazepine, phenytoin, lamotrigine, phenobarbitone, primidone (recently licensed lacosamide associated with lower risk) and the sulpha-derivative zonisamide. Our study provides a summary of severe delayed allergic reactions and offers a pragmatic management pathway for patients suffering a suspected drug-induced rash. We include UK pretreatment screening guidelines, step by step clinical assessment of rash and associated symptoms aiding early identification of patients at risk of developing severe allergic reactions. At the same time our manuscript reviews published data informing best choice and titration of alternative medication when allergy confirmed. Finally we summarize current knowledge on genetic predisposition and other personalized risks of AED allergies identifying gaps in our current understanding.


Assuntos
Assistência Ambulatorial/métodos , Anticonvulsivantes/efeitos adversos , Gerenciamento Clínico , Epilepsia/tratamento farmacológico , Síndrome de Stevens-Johnson/terapia , Adulto , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Epilepsia/diagnóstico , Humanos , Fatores de Risco , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/etiologia
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