Asia Pac Allergy.  2015 Apr;5(2):59-67. 10.5415/apallergy.2015.5.2.59.

Recent advances of pharmacogenomics in severe cutaneous adverse reactions: immune and nonimmune mechanisms

• Dao RL
• Su SC
• Chung WH

• KMID: 2397052
• DOI: http://doi.org/10.5415/apallergy.2015.5.2.59

Abstract

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) are severe cutaneous adverse reactions (SCAR) which are majorly caused by drugs. Though the incidence rate is low, SCAR sometimes can be life-threatening and leads to lifelong sequelae. Many pharmacogenomic associations in immune and nonimmune related genes with the development of SCAR have been discovered recently and the pharmacogenetic tests have been applied to prevent specific drug-induced SCAR. In this review, we discuss the recent advances of pharmacogenomics in SCAR.

Keyword

Stevens-Johnson syndrome; Toxic epidermal necrolysis; Drug reaction with eosinophilia and systemic symptoms

MeSH Terms

Cicatrix
Drug Hypersensitivity Syndrome
Incidence
Pharmacogenetics*
Stevens-Johnson Syndrome

Figure

• 

  Fig. 1 Mechanisms of keratinocyte apoptosis in stevens-Johnson syndrome/toxic epidermal necrolysis. The complex of drug antigen/metabolite-human leukocyte antigen (HLA)-T cell receptor (TCR) initiates immune reactions. Specific HLA allele predisposition and interaction with culprit drug allow the presentation of drug-bound HLA to the TCR which further triggers the activation of CD8+ cytotoxic lymphocytes and a series of specific immune reactions.

• 

  Fig. 2 Worldwide distribution of causative drugs and human leukocyte antigen (HLA) association in Stevens-Johnson syndrome/toxic epidermal necrolysis. ALL, allopurinol; CBZ, carbamazepine; LMT, lamotrigine; MTZ, methazolamide; NVP, nevirapine; OXC, oxcarbazepine; PHT, phenytoin; SMX, sulfamethoxazole.

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