Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN score)
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When to use
Delay from initial drug component intake to index day, i.e. onset of reaction
Drug started on or after the index day
1-4 days
1-4 days in case of previous reaction to the same drug
5-28 days
29-56 days
5-56 days in case of previous reaction to the same drug
> 56 days
Drug present in the body on the index day
Drug continued up to index day or stopped at a time point < 5× the elimination half-life before the index day
Drug stopped at a time point before the index day by > 5× the elimination half-life; liver or kidney function alterations or suspected drug interactions are present
Drug stopped at a time point before the index day by > 5× the elimination half-life; no liver or kidney function alterations or suspected drug interactions
Prechallenge/rechallenge
Stevens-Johnson syndrome/toxic epidermal necrolysis after using the same drug
Stevens-Johnson syndrome/toxic epidermal necrolysis after using a similar drug or other reaction with the same drug
Other reactions after using a similar drug
No known previous exposure to the drug
Prior or subsequent exposure to the drug without any reaction
Dechallenge
Drug stopped or unknown)
Drug continued without harm
Drug risk
High-risk drug according to previous case-control studies
Definite but lower-risk drug according to previous case-control studies
Several previous reports, ambiguous epidemiology results drug "under surveillance")
All other drugs, including newly released ones
No evidence of association from previous epidemiological studies with a sufficient number of exposed controls
Other cause
Another drug with a probable or very probable score without this section
Calculation
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