Desensitization to Oxcarbazepine: Long-Term Efficacy and Tolerability

Lee, Jiwon; Park, Eu Gene; Lee, Munhyang; Lee, Jeehun

doi:10.3988/jcn.2017.13.1.47

Cited by 9 publications

(4 citation statements)

References 40 publications

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“…Published protocols for AED desensitization are available for phenytoin, pentobarbital, lamotrigine, carbamazepine, oxcarbazepine, and valproic acid [96][97][98][99][100][101][102][103]. These protocols utilized small starting doses and most required weeks to months to achieve titration to the full dose.…”

Section: Desensitization (Induced Drug Tolerance)mentioning

confidence: 99%

Rashes and other hypersensitivity reactions associated with antiepileptic drugs: A review of current literature

Mani

Monteleone

Schalock

et al. 2019

Seizure

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This article provides an overview of the pathogenesis and risk factors associated with antiepileptic drug (AED) hypersensitivity reactions, provides prescribing guidelines that may minimize the risk of antiepileptic induced rashes, and discusses treatment options for rashes. Articles indexed in PubMed, Science Citation, and Google Scholar (January 1946-March 2019) were systematic searched using the following key terms: hypersensitivity, rash, antiepileptic, epilepsy, cross-sensitivity, desensitization, patch testing and supplemented with our clinical experiences. Additional references were identified from a review of literature citations. AEDs are associated with cutaneous adverse reactions. Aromatic AEDs and higher titration rates are associated with increased risk of hypersensitivity reaction. Patient characteristics, underlying health conditions, and genetic variations may increase the likelihood of a hypersensitivity reaction. Once a hypersensitivity reaction occurs, the likelihood of cross sensitivity to another AED increases, especially among other aromatic AEDs. Withdrawal of the causal agent and initiation of a lower risk agent usually leads to resolution of symptoms. Desensitization protocols may be an option for patients whose seizures only respond to the AED causing the rash.PubMed, Science Citation, and Google Scholar literature were systematically searched for articles ranging from January 1946 -March 2019. The following key terms were searched: hypersensitivity, rash, antiepileptic, epilepsy, cross-sensitivity, desensitization, and patch testing. Additional references were identified from a review of literature citations. Emphasis was given to treatment guidelines and review articles of the most clinically relevant studies, and the content was supplemented with our clinical experiences. Presentation of hypersensitivity reactions to AEDsThe presentation can be immediate or delayed. The symptoms, diagnosis, and management depend on the type of rash (Table 1). A small study compared the incidence of different types of rashes in people taking antimicrobial agents, anti-inflammatory analgesics,

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Section: Desensitization (Induced Drug Tolerance)mentioning

confidence: 99%

Rashes and other hypersensitivity reactions associated with antiepileptic drugs: A review of current literature

Mani

Monteleone

Schalock

et al. 2019

Seizure

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“…Thus, all of the clinical events occurred within the first month of OXC use regardless of whether or not the initial dose was higher than 450 mg/day. According to the latest study of drug desensitization to OXC [55], the starting dosage during OXC desensitization was 0.1 mg/day, and then the dosage was increased gradually. The time spent in achieving the optimal dose of 10 mg kg −1 •day −1 was 63.6 ± 24.1 days (range 37-124 days), and the time taken to achieve the maximum therapeutic dosage was 116.0 ± 8.2 days (range 47-300 days).…”

Section: Discussionmentioning

confidence: 99%

Association between HLA-A*3201 allele and oxcarbazepine-induced cutaneous adverse reactions in Eastern Han Chinese population

Shi

Qiu

et al. 2019

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To determine genetic associations between oxcarbazepine (OXC)-induced cutaneous adverse drug reactions (cADRs) and human leukocyte antigen (HLA) variants in the Eastern Han Chinese population. Methods: A total of 120 patients were enrolled in this study, including 30 subjects with OXC-induced cADRs (case group) and 90 OXC-tolerant patients (control group). High-resolution HLA genotyping was conducted for HLA-A, HLA-B, HLA-C, and HLA-DRB1, and allele frequencies were compared. Results: No patient carried the HLA-B *1502 allele in the case group, the frequency of HLA-B *1502 allele in the control group was 6.1%. HLA-A*3201 allele was detected in 13.3% of 30 patients with OXC-induced cADRs (4/ 30) and 0% of 90 OXC-tolerant patients (0/90). The difference in HLA-A*3201 frequency between the two groups was statistically significant [P = 0.004, odds ratio (OR) = 15.877, 95% confidence interval (CI) = 1.817-138.720]. Conclusions: Eastern Han Chinese patients with the HLA-A*3201 allele may be more susceptible to OXC-induced cADRs, while the HLA-B*1502 allele is not correlated with it. The precise association between HLA alleles and OXC-induced cADRs warrants further study.

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“…In mild delayed reactions when there are no valid alternatives, the advantages of a desensitization protocol should be evaluated since only few case reports are available. 106,107 While desensitization is generally restricted to IgE-mediated allergic reactions, there may be a role for slow incremental exposure (over days to weeks) depending on the clinical need for a particular AED in the setting of a mild reaction. Protocols on desensitization in these kinds of delayed reactions in pediatric populations are not standardized.…”

Section: Sjs and Ten To Aeds-clinical Casementioning

confidence: 99%

Delayed hypersensitivity to antiepileptic drugs in children

Mori

Blanca‐López

Caubet

et al. 2020

Pediatric Allergy Immunology

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Background: Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life-threatening. Aim: This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature. Results: Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids. Conclusion: Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. How to cite this article: Mori F, Blanca-Lopez N, Caubet J-C, et al. Delayed hypersensitivity to antiepileptic drugs in children.

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Desensitization to Oxcarbazepine: Long-Term Efficacy and Tolerability

Cited by 9 publications

References 40 publications

Rashes and other hypersensitivity reactions associated with antiepileptic drugs: A review of current literature

Rashes and other hypersensitivity reactions associated with antiepileptic drugs: A review of current literature

Association between HLA-A*3201 allele and oxcarbazepine-induced cutaneous adverse reactions in Eastern Han Chinese population

Delayed hypersensitivity to antiepileptic drugs in children

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