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

Abstract

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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