Document Detail

Allopurinol hypersensitivity syndrome: a preventable severe cutaneous adverse reaction?
MedLine Citation:
PMID:  18465047     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Allopurinol is a widely-prescribed urate-lowering agent. Allopurinol hypersensitivity syndrome, a severe form of cutaneous adverse reaction, is associated with significant mortality and morbidity. The aim of this study was to document the clinical presentation of allopurinol hypersensitivity in a local population, examine the indications for urate-lowering therapy and to identify potential associations with such a syndrome. METHODS: Retrospective review was done for all patients who were referred to the dermatology unit of a tertiary hospital for allopurinol hypersensitivity syndrome over a four-year period. RESULTS: Over four years, there were 28 patients with allopurinol hypersensitivity syndrome, of which there were 27 (96 percent) Chinese and one (four percent) Malay. The average age was 69 years. At baseline, 24 patients (86 percent) had renal impairment, and 21 patients (75 percent) had higher dosages of allopurinol. The cutaneous manifestation included generalised maculopapular exanthem (22 patients, 79 percent), Stevens Johnson/toxic epidermal necrolysis overlap (two patients, seven percent) and Stevens-Johnson syndrome (two patients, seven percent) and generalised exfoliative dermatitis (one patient, four percent). Mortality rate was 18 percent. Indications for allopurinol therapy were clear in ten patients (36 percent). CONCLUSION: Allopurinol hypersensitivit y syndrome is a life-threatening cutaneous adverse reaction. Allopurinol should be initiated under clear indications with appropriate dosages. Potential associations with this syndrome include the Chinese race, the elderly, and patients with underlying renal impairment.
H Y Lee; J T Ariyasinghe; T Thirumoorthy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Singapore medical journal     Volume:  49     ISSN:  0037-5675     ISO Abbreviation:  Singapore Med J     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-09     Completed Date:  2008-07-03     Revised Date:  2009-09-29    
Medline Journal Info:
Nlm Unique ID:  0404516     Medline TA:  Singapore Med J     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  384-7     Citation Subset:  IM    
Dermatology Unit, Singapore General Hospital, Outram Road, Singapore 169608.
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MeSH Terms
Aged, 80 and over
Allopurinol / adverse effects*
Drug Hypersensitivity / etiology*,  mortality
Gout Suppressants / adverse effects*
Middle Aged
Retrospective Studies
Reg. No./Substance:
0/Gout Suppressants; 315-30-0/Allopurinol
Comment In:
Singapore Med J. 2009 Sep;50(9):925-6; author reply 927   [PMID:  19787189 ]

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