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

作者：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^*

来源：Genetics in Medicine, 2015, 17(10): 807-814.

DOI：10.1038/gim.2014.195

• allopurinol
• drug hypersensitivity
• HLA-B*58:01 antigen
• immune tolerance
• renal insufficiency, chronic

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.

• 出版日期2015-10