Transl Clin Pharmacol.  2019 Jun;27(2):64-68. 10.12793/tcp.2019.27.2.64.

Antiepileptic drug-induced severe cutaneous adverse reactions and HLA alleles: A report of five cases with lymphocyte activation test

Affiliations
  • 1Department of Clinical Pharmacology, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, Republic of Korea. phshinjg@gmail.com
  • 2Center for Personalized Precision Medicine of Tuberculosis, Inje University College of Medicine, Busan 47392, Republic of Korea.
  • 3Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, Republic of Korea.
  • 4Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan 48108, Republic of Korea.
  • 5Department of Microbiology and Immunology, Inje University College of Medicine, Busan 47392, Republic of Korea.
  • 6Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Republic of Korea.

Abstract

Antiepileptic drugs (AEDs) can induce severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. We performed HLA genotyping and lymphocyte activation tests (LATs) for five AED-induced SCAR patients (three males and two females; aged 40-66 years old). Three patients were treated with carbamazepine (CBZ) for pain control, one was treated with phenytoin (PHT) for seizure prevention, and one was treated with valproic acid (VPA) for seizure prevention. One patient was diagnosed with CBZ-induced DRESS syndrome and the remaining patients were diagnosed with SJS. All patients recovered from SCARs after stopping suspicious drugs and supportive care. LATs were conducted to confirm the culprit drug responsible for inducing SCARs; and LAT results were positive for the suspected culprit drugs, in all except in one case. HLA-A, -B, and -C alleles were determined using PCR-sequence-based typing method. The common alleles of HLA were -A*02:01, -B*51:01, and -C*03:04 which were carried by three patients (60%) for each allele. The patient with CBZ-induced DRESS syndrome carried the HLA-A* 31:01 allele. One patient with CBZ-induced SJS and one patient with VPA-induced SJS carried the HLA-B*15:11 allele. No patients carried the HLA-B*15:02 allele, which is a known risk allele of AED-induced SCARs. Further investigation of the three common alleles found in the five AED-induced SCARs patients is needed. We demonstrated the usefulness of LAT for confirming the culprit drug.

Keyword

Antiepileptic drugs; HLA class I alleles; Lymphocyte activation test; Severe cutaneous adverse reactions

MeSH Terms

Alleles*
Anticonvulsants
Carbamazepine
Cicatrix
Drug Hypersensitivity Syndrome
Female
HLA-A Antigens
Humans
Long-Acting Thyroid Stimulator
Lymphocyte Activation*
Lymphocytes*
Male
Methods
Phenytoin
Seizures
Stevens-Johnson Syndrome
Valproic Acid
Anticonvulsants
Carbamazepine
HLA-A Antigens
Long-Acting Thyroid Stimulator
Phenytoin
Valproic Acid
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