Drug hypersensitivity syndrome

Abstract

Drug hypersensitivity syndrome (DHS) is an adverse drug reaction commonly associated with the aromatic antiepileptic drugs (AEDs), viz., phenytoin (PHT), carbamazepine (CBZ), phenobarbital (PB), lamotrigine, primidone, etc. It can also be caused by other drugs, such as sulfonamides, dapsone, minocycline, gold derivatives, cyclosporine, captopril, diltiazem, terbinafine, azathioprine and allopurinol. Diagnosis of DHS may be difficult because of the variety of clinical and laboratory abnormalities and manifestations and because the syndrome may mimic infectious, neoplastic or collagen vascular disorders. The risk for developing hypersensitivity within 60 days of the first or second prescription in new users of PHT or CBZ was estimated to be 2.3-4.5 per 10,000 and 1-4.1 per 10,000, respectively. The syndrome is defined by the fever, skin rash, lymphadenopathy and internal organ involvement within the first 2-8 weeks after initiation of therapy. Internal manifestations include, among others, agranulocytosis, hepatitis, nephritis and myositis. Insufficient detoxification may lead to cell death or contribute to the formation of antigen that triggers an immune reaction. Cross-reactivity among PHT, CBZ and PB is as high as 70%-80%. Management mainly includes immediate withdrawal of the culprit drug, symptomatic treatment and systemic steroids or immunoglobulins.

Allopurinol-induced DRESS syndrome

“…Allopurinol, sulphasalazine, nevirapine, and penicillamine are other such drugs. [2356] In a study of 38 patients with DRESS syndrome, all opurinol was found to be responsible for 5.3% of the cases. [7]…”

“…High-dose corticosteroids can provide a dramatic improvement in clinical condition. [2357] Early cessation of the drug implicated in the development of DRESS syndrome will result in a better outcome. The DRESS syndrome can cause life-threatening multi-organ failure.…”

“…It is a syndrome, caused by exposure to certain medications that may cause a rash, fever, inflamation of internal organs, lymphadenopathy, and characteristic hematologic abnormalities such as eosinophilia, thrombocytopenia, and atypical lymphocytosis.Allopurinol can cause DRESS syndrome in 2-6 weeks after allopurinol therapy. [2–4] In this text, we present a patient with complaints of fever, jaundice, dyspnea, and generalized rash after 3 months of allopurinol treatment for gout.…”

Lamotrigine induced DRESS syndrome

“…The skin, liver and hematologic system are most commonly involved, with cutaneous changes being the most apparent. [6] The presence of the 2 criteria, as given by Bocquet et al ., has high sensitivity (>95%) but weak specificity (<80%). [7] [Table 1].…”

“…In severe cases, pulse therapy with high dose of intravenous methyl prednisolone, plasmapharesis and human intravenous immunoglobin may be tried. [6]…”