HLA-B58 can help the clinical decision on starting allopurinol in patients with chronic renal insufficiency

Abstract

In this study, the incidence of allopurinol-induced SCARs was considerably high in CRI patients with HLA-B58. This finding indicates that the presence of HLA-B58 may increase the risk of allopurinol-induced SCARs. Screening tests for HLA-B58 in CRI patients will be clinically helpful in preventing severe allopurinol hypersensitivity reactions.

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

“…Considering that the phenotype frequency of HLA-B*58:01 in South Korea is 12.2% (ref. 19) and the previous incidence rate of 18% in HLA-B*58:01-positive patients with CRI, 15 the estimated number of patients prone to allopurinol-induced SCARs was 7.58 of 345 Korean subjects with CRI.…”

“…14,15 Most exciting is that our study is the first to provide substantial evidence to support the effectiveness of a tolerance induction protocol to prevent the development of allopurinol-induced hypersensitivity response in a group of high-risk patients. This unique design is based on the idea that primary prevention of hypersensitivity reaction can be attained by inducing immunological tolerance with the introduction of a "desensitization protocol."…”

“…15 Whereas the previous retrospective study revealed a 2.0% incidence of allopurinol-induced SCARs, no SCARs developed after 90 days of allopurinol administration after the introduction of HLA-B*58:01 screening and a tolerance induction protocol (2.0 vs. 0%; P = 0.003; Figure 3). Of the 46 HLA-B*58:01-positive patients, 8.28 patients were expected to have SCARs, considering the 18% incidence of SCARs in the previous retrospective cohort study of a similar population.…”

“…Considering the incidence of SCAR in our previous retrospective cohort study, 15 about US $400,000 would have been spent for 8.28 patients with potential SCARs among 401 study subjects without HLA-B*58:01 screening. Therefore, the cost of the HLA-B allele test for 401 study subjects (US $19,667) was only 4.9% of the estimated cost of treating potential SCARs.…”

Allergic reactions: key aspects and new perspectives

“…Es por esto, que se habla de la epigenética, es decir cómo influyen los factores ambientales en la expresión de ciertos genes (2,11). En la tabla 3 se dan ejemplos de los genes relacionados con algunas enfermedades alérgicas (61-68) y en la tabla 4 los estudios de HLA en hipersensibilidad a medicamentos (69)(70)(71)(72)(73)(74)(75).…”