Allopurinol hypersensitivity syndrome, although rare, is a significant concern for physicians who use the drug to lower serum uric acid in patients with gout. More detailed information about the symptoms, causes, and treatments of allopurinol hypersensitivity syndrome is available below symptoms of allopurinol hypersensitivity syndrome. Methods we used the 5% medicare beneficiary sample. There is a genetic predisposition to drug hypersensitivity syndrome. Historical risk factors for ahs include renal insufficiency and diuretic use3, and because the syndrome can prove fatal. Jun 15, 2010 allopurinol hypersensitivity syndrome, although rare, is a significant concern for physicians who use the drug to lower serum uric acid in patients with gout. The risk for hypersensitivity syndrome from a specific gout treatment increased as the starting dose corrected for egfr, increased. The occurrence ot hypersensitivity reactions to allopurinol may be increased in patients with decreased renal function receiving thiazides and allopurinol concurrently. It usually begins 2 to 6 weeks after starting allopurinol. Zyloprim is known chemically as 1, 5dihydro4 hpyrazolo 3, 4 d pyrimidin4one. Although allopurinol hypersensitivity syndrome, a severe cutaneous adverse reaction, is less common, affecting 0.
It is a xanthine oxidase inhibitor which is administered orally. Although participation of other opportunistic viral infections has also been reported, the mechanisms by which any of these contribute to ahs are still. Historical risk factors for ahs include renal insufficiency and diuretic use 3, and because the syndrome can. Allopurinol is the leading choice of uratelowering therapy for gout 95% of treated cases. Allopurinol is a highly effective, cheap and simple therapy for gout if dosing is adequate and patients adhere to the therapy. A medline search key terms hepatitis, interstitial nephritis, severe hypersensitivity, severe toxicity, vasculitis. The syndrome is often characterized by fever, severe and profuse skin. The aim of this study is to document the clinical presentation of allopurinol hypersensitivity syndrome in a local. Jan 17, 2020 dress also known as drug hypersensitivity syndrome has been reported. The allopurinol hypersensitivity syndrome sciencedirect.
Drug rash with eosinophilia and systemic symptoms dress syndrome or drug hypersensitivity syndrome dhs has been reported in association with allopurinol use. Viruses may trigger allopurinol hypersensitivity syndrome. Allopurinol associated scar severe cutaneous adverse drug reaction including stevensjohnson syndrome sjs and toxic epidermal necrolysis ten has been shown to be associated with the human leukocyte antigen hla b58. Recent euroscar studies demonstrated that allopurinol is the leading cause of stevensjohnson syndrome sjs and toxic epi. Frequently, the rash can involve ulcers of the mouth, throat, nose, genitals and conjunctivitis red and swollen eyes. Describe risk factors for and clinical features of allopurinol hypersensitivity syndrome in patients with gout who are receiving allopurinol. Describe the effect of the starting dose of allopurinol on the risk for allopurinol hypersensitivity syndrome in patients with gout.
Sir, a relationship between allopurinol hypersensitivity syndrome ahs and viral infections, especially with human herpes virus hhv6, has been suspected since the first report of ahs in 1970. The aim of this study was to document the clinical presentation of allopurinol hypersensitivity in a local population, examine the indications for uratelowering therapy and to identify. Allopurinol hypersensitivity syndrome typically occurs in persons with preexisting kidney failure 119 weeks to months after allopurinol is begun, the patient develops a morbilliform eruption. Hypersensitivity reactions with allopurinol and febuxostat. Allopurinolinduced hypersensitivity syndrome request pdf. Allopurinol fda prescribing information, side effects and uses.
The allopurinol hypersensitivity syndrome, which occurs in about 1 in patients prescribed allopurinol, includes stevensjohnson syndrome, toxic epidermal necrolysis, and dress. A hypersensitivity reaction hsr is an important, but rareuncommon adverse event associated with the use of allopurinol,1 the most commonly used uratelowering therapy ult for the treatment of gout. Introduction allopurinol is a widelyprescribed uratelowering agent. Over 60% of patients had received allopurinol for asymptomatic hyperuricemia. Regarding the potential implications of our findings in other populations, allopurinol is a common drug that is associated with severe cutaneous adverse reactions in different ethnic groups, including asians and europeans. Stevensjohnson syndrome and toxic epidermal necrolysis are variants of the same mucocutaneous blistering reaction disease and carry high. However, this drug is one of the most common causes of severe cutaneous adverse reactions scar, an umbrella term encompassing drug hypersensitivity syndrome, stevensjohnson syndrome sjs, and toxic. Allopurinol hypersensitivity syndrome symptoms, diagnosis. The allopurinol hypersensitivity syndrome journal of the american. Allopurinol hypersensitivity syndrome and acute myocardial. Allopurinol hypersensitivity syndrome ahs is an idiosyncratic cellmediated hypersensitivity to allopurinol 1 characterized by a diffuse morbilliform rash which can evolve into exfoliative dermatitis, eosinophilia, worsening renal function, and fever 2. Drug hypersensitivity syndrome is a delayed t cell mediated reaction. Sep 29, 2015 starting dose is a risk factor for allopurinol hypersensitivity syndrome. Zyloprim allopurinol has the following structural formula.
Allopurinol hypersensitivity syndrome ahs is a severe and sometimes lifethreatening adverse drug reaction. Allopurinol hypersensitivity syndrome in patients with hematological. Serious skin rashes hypersensitivity syndrome, stevens johnson syndrome, toxic epidermal necrolysis have been reported in patients taking allopurinol. Symptoms of allopurinol hypersensitivity syndrome including 6 medical symptoms and signs of allopurinol hypersensitivity syndrome, alternative diagnoses, misdiagnosis, and correct diagnosis for allopurinol hypersensitivity syndrome signs or allopurinol hypersensitivity syndrome symptoms. Febuxostat hypersensitivity the journal of rheumatology. Adverse reactions to allopurinol frequently involve the skin, liver, kidneys, gastrointestinal system and bone marrow. Description and guidelines for prevention in patients with renal insufficiency. Allopurinol hypersensitivity syndrome ahs is a disorder involving multiple organs, which may be accompanied by cutaneous adverse reactions. Drug rash with eosinophilia and systemic symptoms dress syndrome, also known as druginduced hypersensitivity syndrome, is an uncommon severe systemic hypersensitivity drug reaction.
The records of 8 patients with the al lopurinol hypersensitivity syndrome evaluated at the. Starting dose is a risk factor for allopurinol hypersensitivity syndrome. More detailed information about the symptoms, causes, and treatments of allopurinol hypersensitivity syndrome is available below. Although participation of other opportunistic viral infections has also been reported, the mechanisms by which any of these contribute to ahs are still unknown. Ahs is categorized as a severe cutaneous adverse reaction scar 6. Hypersensitivity reactions to allopurinol, a drug commonly used in the treatment of hyperuricemia, are being reported with increasing frequency.
Symptoms of allopurinol hypersensitivity syndrome including 6 medical symptoms and signs of allopurinol hypersensitivity syndrome, alternative diagnoses, misdiagnosis, and correct diagnosis for allopurinol hypersensitivity syndrome signs or. Allopurinol hypersensitivity syndrome ahs, a rare but potentially fatal adverse reaction in patients beginning allopurinol therapy for gout, might be largely avoided by keying the starting dose to kidney. How to prevent allopurinol hypersensitivity reactions. Patients receiving allopurinol are at risk of developing the allopurinol hypersensitivity syndrome, an immunologic reaction to the drug, characterized by multiple abnormalities such as fever, rash, decreased renal function, hepatocellular injury, leukocytosis, and eosinophilia. Fatal allopurinol hypersensitivity syndrome after treatment. Allopurinol, sold under the brand name zyloprim among others, is a medication used to decrease high blood uric acid levels. Allopurinol hypersensitivity syndrome in patients with. Discontinuation of allopurinol did achieve the ultimate goal of palliative care, which was to make the patient as comfortable as possible. We identified the characteristics and clinical outcomes of chemotherapyassociated ahs in patients with hematological malignancies. A defect in the way the liver metabolises drugs may be responsible.
The syndrome includes many of the severe reactions described above, and is potentially lifethreatening and fatal. Sep 15, 2005 the exact mechanism for the development of allopurinol hypersensitivity syndrome is unknown. If you have any further questions, ask your doctor or pharmacist. It has been reported that symptoms may develop in approximately 1 week from initiating allopurinol therapy, but longer latency periods have also been reported. Hlab5801 testing to prevent allopurinol hypersensitivity. Reactivation of human herpesvirus 6 hhv6, the cause of roseola or. Request pdf allopurinolinduced hypersensitivity syndrome allopurinol is an effective urate lowering drug, which is usually welltolerated with no adverse effects in most cases, but about 2%. Symptoms can include liver and kidney damage, stevensjohnson syndrome, and toxic epidermal necrolysis. Beyond renal dosing to help reduce the risk of ahs, the recently. Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe mult iorgan disease. It is specifically used to prevent gout, prevent specific types of kidney stones and for the high uric acid levels that can occur with chemotherapy. Allopurinol hypersensitivity syndrome, a severe form of cutaneous adverse reaction, is associated with significant mortality and morbidity. A relationship between allopurinol hypersensitivity syndrome ahs and viral infections, especially with human herpes virus hhv6, has been suspected since the first report of ahs in 1970. Extra vigilance, for the signs of hypersensitivity syndrome or sjsten is required and the patient should be informed of the need to stop treatment immediately and permanently at the first appearance of symptoms see section 4.
Allopurinol hypersensitivity syndrome as a cause of. We describe a 61yearold male patient who was treated with allopurinol and developed fever, a skin rash, eosinophilia and severe renal and liver dysfunction. Furthermore, febuxostat appears to induce hypersensitivity syndrome less frequently than allopurinol, and is well tolerated by most ahs patients 34,36. An immune reaction to the ingestion of a drug called allopurinol. Moreover, high starting doses of allopurinol might increase the risk of serious adverse reactions including drug hypersensitivity syndrome with rash, eosinophilia and. The most important and critical characteristics are the pre sence of visceral. It is estimated to occur in 1 in every to 10,000 drug exposures. Objective to assess the risk of hypersensitivity reactions hsrs with allopurinol and febuxostat in a populationbased study. Gout treatment dosage affects risk for hypersensitivity. Fulltext pdf economic burden of venoocclusive disease in patients with b cell acute lymphoblastic leukemia in the united.
The aim of this study was to document the clinical presentation of allopurinol hypersensitivity in a local population, examine the indications for. Moreover, high starting doses of allopurinol might increase the risk of serious adverse reactions including drug hypersensitivity syndrome with rash, eosinophilia and systemic symptoms dress. It is taken by mouth or injected into a vein common side effects when used by mouth include itchiness and rash. Allopurinol hypersensitivity and dress syndrome the american.
There is reluctance from many prescribers of allopurinol, most of whom are general practitioners, to increase the dose above 300 mgday despite advice in the product information that supports a maximum dose of 900 mgday. Our observation suggests that allopurinol toxicity should be considered as an additional cause of. Although ahs is rare, the number of patients with gout requiring allopurinol is high, and there are sufficient overall cases of ahs to warrant consideration of preventive measures. The exact mechanism for the development of allopurinol hypersensitivity syndrome is unknown. Pharmacologic studies have suggested that the serum concentration of. Allopurinol hypersensitivity syndrome as a cause of hepatic. Dosage adjustment might have reduced the occurrence or severity of the rash. Incidence of allopurinol hypersensitivity syndrome. Beyond renal dosing to help reduce the risk of ahs, the recently discovered strong associations. Each scored white tablet contains 100 mg allopurinol and the. Allopurinol hypersensitivity syndrome ahs is an idiosyncratic cellmediated hypersensitivity to allopurinol1 characterized by a diffuse morbilliform rash which can evolve into exfoliative dermatitis, eosinophilia, worsening renal function, and fever2. Other involvement such as gastrointestinal bleeding is common. Allopurinol hypersensitivity syndrome ahs is a disorder involving multiple organs, which may be accompanied by cutaneous adverse. Jun 29, 2015 allopurinol hypersensitivity syndrome ahs is a disorder involving multiple organs, which may be accompanied by cutaneous adverse reactions.
Allopurinol hypersensitivity syndrome ahs was first reported by lang 4 in 1979, and diagnostic criteria were established in 1986 5. Serious allopurinolrelated adverse events for example, allopurinol hypersensitivity syndrome ahs are rare, but are associated with high morbidity and mortality. The allopurinol hypersensitivity syndrome unpecessary morbidity and mortality joyce 2. The syndrome is potentially lifethreatening and fatal. We used multivariableadjusted cox regression analyses to compare the hazard ratio hr of. Tissue damage is due to cytotoxic t cells and cytokine release. Allopurinol use and risk of fatal hypersensitivity reactions. Rasburicase is a potent recombinant form of urate oxidase, which can metabolize uric acid to the more highly soluble compound allantoin. Information for the user allopurinol 100mg and 300mg tablets allopurinol read all of this leaflet carefully before you start taking this medicine because it contains important information for you. Allopurinol hypersensitivity syndrome singapore medical journal.
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