Allopurinol hypersensitivity syndrome

From WikiMD.com - Food, Medicine & Wellness Encyclopedia

Dr.Prab.jpg

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Allopurinol hypersensitivity syndrome
Chemical structure of allopurinol
Synonyms N/A
Pronounce N/A
Specialty N/A
Symptoms Rash, fever, eosinophilia, hepatitis, renal failure
Complications Stevens-Johnson syndrome, toxic epidermal necrolysis, organ failure
Onset Typically within weeks of starting allopurinol
Duration Variable, depending on severity and treatment
Types N/A
Causes Hypersensitivity reaction to allopurinol
Risks HLA-B*5801 allele, renal impairment, high starting dose of allopurinol
Diagnosis Clinical evaluation, skin biopsy, blood tests
Differential diagnosis Drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome, toxic epidermal necrolysis
Prevention Genetic testing for HLA-B*5801 in high-risk populations, cautious dosing
Treatment Discontinuation of allopurinol, supportive care, corticosteroids
Medication N/A
Prognosis Variable; can be life-threatening if not treated promptly
Frequency Rare
Deaths N/A


Allopurinol Hypersensitivity Syndrome[edit | edit source]

Allopurinol hypersensitivity syndrome (AHS) is a rare but serious adverse reaction to the medication allopurinol, which is commonly used to treat gout and hyperuricemia. This syndrome is characterized by a combination of severe skin reactions, systemic symptoms, and internal organ involvement.

Clinical Features[edit | edit source]

AHS typically presents with a constellation of symptoms that may include:

  • Severe skin reactions: These can range from maculopapular rash to more severe forms such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
  • Fever: Patients often experience high fevers as part of the systemic response.
  • Hepatitis: Liver involvement is common, with elevated liver enzymes indicating hepatic inflammation.
  • Renal failure: Acute kidney injury can occur, often necessitating careful monitoring and management.
  • Eosinophilia: An elevated eosinophil count is frequently observed in blood tests.

Pathophysiology[edit | edit source]

The exact mechanism of AHS is not fully understood, but it is believed to be an immune-mediated hypersensitivity reaction. Genetic factors, such as the presence of the HLA-B*5801 allele, have been associated with an increased risk of developing AHS, particularly in certain ethnic groups.

Diagnosis[edit | edit source]

Diagnosis of AHS is primarily clinical, based on the presentation of symptoms and a history of recent allopurinol use. Laboratory tests may show elevated liver enzymes, renal impairment, and eosinophilia. Skin biopsy can be performed to confirm severe cutaneous adverse reactions like SJS/TEN.

Management[edit | edit source]

The cornerstone of management is the immediate discontinuation of allopurinol. Supportive care is critical and may include:

  • Hospitalization: Patients with severe reactions often require intensive care.
  • Corticosteroids: These may be used to reduce inflammation and immune response.
  • Hydration and renal support: Ensuring adequate hydration and monitoring renal function is essential.
  • Treatment of skin lesions: In cases of SJS/TEN, specialized wound care is necessary.

Prevention[edit | edit source]

Screening for the HLA-B*5801 allele in high-risk populations before starting allopurinol can help prevent AHS. Alternative medications for managing hyperuricemia should be considered in patients with a positive genetic test.

Related Pages[edit | edit source]

WikiMD
Navigation: Wellness - Encyclopedia - Health topics - Disease Index‏‎ - Drugs - World Directory - Gray's Anatomy - Keto diet - Recipes

Search WikiMD

Ad.Tired of being Overweight? Try W8MD's physician weight loss program.
Semaglutide (Ozempic / Wegovy and Tirzepatide (Mounjaro / Zepbound) available.
Advertise on WikiMD

WikiMD's Wellness Encyclopedia

Let Food Be Thy Medicine
Medicine Thy Food - Hippocrates

Medical Disclaimer: WikiMD is not a substitute for professional medical advice. The information on WikiMD is provided as an information resource only, may be incorrect, outdated or misleading, and is not to be used or relied on for any diagnostic or treatment purposes. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. WikiMD expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. By visiting this site you agree to the foregoing terms and conditions, which may from time to time be changed or supplemented by WikiMD. If you do not agree to the foregoing terms and conditions, you should not enter or use this site. See full disclaimer.
Credits:Most images are courtesy of Wikimedia commons, and templates, categories Wikipedia, licensed under CC BY SA or similar.

Contributors: Prab R. Tumpati, MD