An effective strategy to prevent allopurinol-induced hypersensitivity by HLA typing
- Authors
- Jung , Jae Woo; Kim, Dong-Ki; Park, Heung-Woo; Oh, Kook-Hwan; Joo, Kwon-Wook; Kim, Yon-Su; Ahn, Curie; Lee, Kyung Wha; Cho, Sang-Heon; Min, Kyung-Up; Kang, Hye-Ryun
- Issue Date
- Oct-2015
- Publisher
- NATURE PUBLISHING GROUP
- Keywords
- allopurinol; drug hypersensitivity; HLA-B*58:01 antigen; immune tolerance; renal insufficiency, chronic
- Citation
- GENETICS IN MEDICINE, v.17, no.10, pp 807 - 814
- Pages
- 8
- Journal Title
- GENETICS IN MEDICINE
- Volume
- 17
- Number
- 10
- Start Page
- 807
- End Page
- 814
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/9045
- DOI
- 10.1038/gim.2014.195
- ISSN
- 1098-3600
1530-0366
- 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 HLAB*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 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 HLAB*58:01-positive patients.
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