Cross-sensitivity of skin rashes with antiepileptic drug use

Abstract

Cross-sensitivity rates between certain antiepileptic drugs (AEDs) are high, especially when involving carbamazepine and phenytoin. Specific cross-sensitivity rates provided here may be useful for AED selection and counseling in individual patients.

Safety and Tolerability of Antiepileptic Drug Treatment in Children with Epilepsy

“…Cross-sensitivity among aromatic AEDs occurs in about half of patients. [108] In particular, caution should be taken when prescribing LTG and OXC in patients with a history of rash to another AED or non-AED medication. [108] …”

A Case Report of Phenytoin and Carbamazepine Cross-Reactivity

“…Genetically determined abnormalities in enzyme system resulting in inability to detoxify toxic metabolite could be the probable mechanism in the pathogenesis of DRESS syndrome [6,7,9]. Reactive, toxic metabolites irreversibly modify cellular proteins and cause cell damage or act as hapten to elicit an immune response [2,4]. Thus, both pharmacogenetic and immunologic mechanism may play an important role in anticonvulsant-induced DRESS syndrome [2].…”

“…Many studies have described the cross-reactivity among the aromatic anticonvulsants as a complication which occurs due to worsening of the initial features of DRESS syndrome when switching from a sensitive anticonvulsant to a cross-reactive anticonvulsant [2]. The aromatic anticonvulsants such as phenytoin, carbamazepine and phenobarbitone are first-line drugs to treat convulsions and are known to cause maculopapular reactions with a cross-reactivity among them [4]. We report a case of cross-reactivity between phenytoin and carbamazepine.…”

Atypical DRESS Syndrome Induced by Lenalidomide in Chronic Hemodialysis

“…Moreover, cross-reacting drugs should also be strictly avoided. Cross-reactivity between chemically similar anticonvulsants has been documented in association with skin rash, especially involving carbamazepine and phenytoin [19]. suspicion because of the extended variability in clinical presentations.…”