Predicting possible zonisamide hypersensitivity syndrome

Abstract

Sulphamethoxazole-HSR but not AC-HSR patients may present a cross-reactivity to ZNS-HSR. The use of LTA to predict a possible ZNS reaction is recommended for SMX-sensitive individuals who prescribed ZNS.

Sulfonamide cross-reactivity: Is there evidence to support broad cross-allergenicity?

“…Neuman et al 77 conducted a study to determine if cross-sensitivity exists among zonisamide, other anticonvulsants, and sulfamethoxazole. Patients included in the study had hypersensitivity reactions after receiving antiepileptic drugs (carbamazepine, phenytoin, or phenobarbital) or sulfamethoxazole.…”

“…77 Ritter et al 77 conducted a retrospective chart review that identified 15 adults and children who had reported a sulfa allergy manifesting as a rash and had been treated with zonisamide. None of the patients had a rash or other type of allergic reaction while taking zonisamide.…”

Genetic and immune predictors for hypersensitivity syndrome to antiepileptic drugs

“…9,18,20,21 Skin manifestations include exanthematous rash, blistering eruptions such as erythema multiforme, SJS and TEN. 16,[22][23][24][25] SJS and TEN are severe cutaneous adverse reactions (SCAR). [26][27][28][29][30][31][32][33][34] Epidermal detachment below 10% is defined as SJS, whereas it is considered TEN above 30% [35,36].…”

“…DILI may lead to liver failure and transplant. 10,25 Regardless of ethnicity, HSR predisposition can be predicted by the in vitro lymphocyte toxicity assay (LTA). 52,53 The mitochondrial enzyme succinate dehydrogenase-based LTA was validated versus clinical manifestations.…”

“…The LTA was validated for AEDs such as CBZ, PHY, valproic acid, zonisomide and Phenobarbital. 25,53 The HSR is a complex clinical manifestation, whose diagnosis rests mainly on clinical data. We demonstrated that predisposed individuals have lymphocytes that show cytotoxicity when exposed to the incriminated drug in vitro.…”