An effective strategy to prevent allopurinol-induced hypersensitivity by HLA typing.

Abstract

PURPOSE:

This study was conducted to evaluate the usefulness of human leukocyte antigen (HLA) typing in preventing allopurinol-induced severe cutaneous adverse reactions (SCARs) through the application of an allopurinol tolerance induction protocol or prescription of other alternative medications in high-risk patients.

METHODS:

HLA typing was performed in patients with chronic renal insufficiency who needed allopurinol. HLA-B*58:01-negative patients were prescribed the usual dose of allopurinol. For HLA-B*58:01-positive patients, administration of either allopurinol based on a 28-day tolerance induction protocol or alternative medications was initiated. Hypersensitivity reactions were surveyed for 90 days and compared with the result of a previous retrospective cohort study.

RESULTS:

Among a total of 401 study subjects, no SCARs were noted in HLA-B*58:01-positive patients with application of the tolerance induction protocol (n = 30) or alternative medications (n = 16), nor were any SCARs observed in HLA-B*58:01-negative patients who started allopurinol at the usual dose (n = 355). Compared with the previous retrospective cohort study, a significant reduction in SCARs was observed in HLA-B*58:01-positive patients (0 vs. 18%; P = 0.002).

CONCLUSION:

This study shows the usefulness of HLA-B*58:01 screening in identifying patients at high risk for the development of allopurinol-induced SCARs and suggests that application of a tolerance induction protocol or alternative medications could be an effective strategy to prevent allopurinol-induced SCARs in HLA-B*58:01-positive patients.

• Authors: Jae-Woo Jung, Dong-Ki Kim, Heung-Woo Park, Kook-Hwan Oh, Kwon-Wook Joo, Yon-Su Kim, Curie Ahn, Kyung Wha Lee, Sang-Heon Cho, Kyung-Up Min, Hye-Ryun Kang
• Journal: Genetics in medicine : official journal of the American College of Medical Genetics (Genet Med) Vol. 17 Issue 10 Pg. 807-14 (Oct 2015) ISSN: 1530-0366 [Electronic] United States
• PMID: 25634024 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• HLA-B Antigens
• Histocompatibility Antigens
• Allopurinol

Topics

• Adult
• Aged
• Alleles
• Allopurinol (administration & dosage, adverse effects)
• Desensitization, Immunologic
• Drug Hypersensitivity (diagnosis, epidemiology, genetics, immunology, prevention & control)
• Female
• HLA-B Antigens (genetics, immunology)
• Histocompatibility Antigens (genetics, immunology)
• Histocompatibility Testing
• Humans
• Immune Tolerance
• Incidence
• Male
• Middle Aged
• Risk Factors