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- Page navigation anchor for RE: Prevention of allopurinol-associated adverse cutaneous drug reactions in high-risk patient groups in CanadaRE: Prevention of allopurinol-associated adverse cutaneous drug reactions in high-risk patient groups in Canada
Two recent Canadian publications (1,2) have highlighted the importance of screening at-risk populations for the development of severe cutaneous adverse drug reactions (SCARs) to the uric acid-lowering medication, allopurinol. These reactions include Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) and lead to prolonged hospital admissions, elevated morbidity/mortality, and long-term sequelae. At-risk East Asian populations can be tested for presence of the HLA-B*58:01 genotype prior to prescribing allopurinol, eliminating the risk of SCAR due to this drug in this population. Unfortunately, HLA-B*58:01 genotype testing is underutilized in British Columbia even though East Asians comprise a substantial proportion of the population (1). The study by Yokose C et al. clarifies other risk factors for SCARs such as heart disease and chronic kidney disease and was also conducted using a British Columbian data set (2).
Both studies demonstrate the need to increase utilization of preventive screening. Lead prescribers of allopurinol are primary care providers, internists, rheumatologists and emergency department physicians. Knowledge translation to allow for SCAR prevention can be achieved by 1) physician-directed programs which highlight which groups are at risk and availability of HLA testing; 2) patient educational programs to increase awareness of SCARs related to allopurinol, and the need f...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Allopurinol and cutaneous reactionsRE: Allopurinol and cutaneous reactions
Genotyping for HLA antigens like HLA-B *5801 is recommended before initiating allopurinol therapy in hyperuricemic patients. This was due to Allopurinol induced cutaneous adverse reactions (CARs) reported in certain populations. In certain cases hypersensitivity syndrome with epidermal necrolysis with hepatic and renal failure are observed in allpurinol treat patients. CARs are reported to be a great concern following Allopurinol therapy, alternative drugs like febuxostat that could inhibit xanthine oxidase activity are being tried.1-2With fewer drugs to treat patients with Gout it will be prudent to do genotype analyses of specific HLA antigens known to be associated with such CARs. Cases like these seem to suggest that Pharmacogenomics may become one of the key elements in future drug therapy.3 Uric acid is now considered as a risk factor cardiovascular diseases as well as a prooxidant. Prudence must play an important role in prescribing drugs with know side effects.
1.Lin CW, Huang W, Chao PH, Chen WW, Hsiao FY. Risk of cutaneous adverse reactions associated with allopurinol or febuxostat in real-world patients: A nationwide study. Int J Clin Pract. 2019 May;73(5):e13316. doi: 10.1111/ijcp.13316. Epub 2019 Feb 28.
2. http://www.hsa.gov.sg/DHCPL
3. Pharmacogenomics, 2015 16: 1781-93Competing Interests: None declared.