Skip to main content
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 for preventative genetic testing and 3) “pop-ups” in hospital and community pharmacies to prompt the pharmacist to assess whether HLA testing is indicated or has been ordered. This strategy is crucial to eliminating SCARs due to allopurinol.
Marisa Ponzo MD-PhD, FRCPC
Clinical Instructor
University of British Columbia
Department of Dermatology and Skin Sciences
[email protected]
Jan Dutz MD, FRCPC
Department Head
University of British Columbia
Department of Dermatology and Skin Sciences
[email protected]
References:
1. Ponzo MG, Miliszewski M, Kirchhof MG, Keown PA, Dutz JP. HLA-B*58:01 Genotyping to Prevent Cases of DRESS and SJS/TEN in East Asians Treated with Allopurinol-A Canadian Missed Opportunity. J Cutan Med Surg. 2019 Aug 5.
2. Yokose C, Lu N, Xie H, Li L, Zheng Y, McCormick N, Rai SK, Aviña-Zubieta JA, Choi HK. Heart disease and the risk of allopurinol-associated severe cutaneous adverse reactions: a general population-based cohort study. CMAJ. 2019 Sep 30;191(39):E1070-E1077.