Analysis of six cases of allopurinol hypersensitivity syndrome / 中国基层医药

Objective To analyze the characteristics of allopurinol hypersensitivity syndrome(AH),and pro-vide reference for clinical rational drug use.Methods AH cases induced by oral allopurinol administration were col-lected by dermatologists from January 1995 to January 2015 in our hospital,and 6 cases of the AH were statistically analyzed.Results All cases of AH were male and characterized by skin lesions,fever and damage of liver and kidney function.Although promptly managed,1 case of AH was mainly systemic damaged and died of multiple organ failure and the rest of those cases recuperated.Conclusion AH is an severe complication induced by allopurinol.The clini-cal medication should be strictly monitored in accordance with the instructions to reduce the incidence of AH and ensure medication safety.

Allopurinol hypersensitivity syndrome in patients with hematological malignancies: characteristics and clinical outcomes

BACKGROUND/AIMS: Allopurinol is a urate-lowering agent that is commonly used to prevent chemotherapy-related hyperuricemia. Allopurinol hypersensitivity syndrome (AHS) is a disorder involving multiple organs, which may be accompanied by cutaneous adverse reactions. We identified the characteristics and clinical outcomes of chemotherapy-associated AHS in patients with hematological malignancies. METHODS: This retrospective single-center study included 26 AHS patients (11 with and 15 without hematological malignancies) admitted to Seoul St. Mary's Hospital. AHS was defined using the criteria of Singer and Wallace. Comparisons were made using the Mann-Whitney U test and Fisher exact test as appropriate. RESULTS: In patients with a hematological malignancy and AHS, statistically significant differences were observed in terms of younger age at onset; shorter duration of exposure; higher starting and maintenance doses of allopurinol; lower incidence of eosinophilia, leukocytosis, and underlying renal insufficiency; and more frequent occurrence of fever compared to AHS patients without a hematological malignancy. Two AHS patients with a hematological malignancy were examined for human leukocyte antigen (HLA)-B typing, but neither patient harbored the HLA-B*5801 allele. All of the patients ceased allopurinol treatment, with most patients making a full recovery. Two patients in the study died; however, these deaths were unrelated to AHS. One patient developed serious sequelae of AHS that required hemodialysis. CONCLUSIONS: Physicians who prescribe allopurinol for the prevention of chemotherapy-related hyperuricemia should be aware of the unique risk of AHS, even in patients with hematological malignancies who do not have known risk factors for AHS. Novel urate-lowering agents should be considered alternative treatments.

Two Cases of Allopurinol Hypersensitivity Syndrome in Patients Receiving Thiazide Therapy due to Hypertension / 대한피부과학회지

Allopurinol hypersensitiviy syndrome (AHS) is a rare immunologic response to allopurinol, characterized by multiple findings such as skin rash, fever, hepatic dysfunction, decreased renal function, leukocytosis and eosinophilia. The risk developing AHS tends to increase in patients receiving thiazide therapy or in those who have a pre-existing renal disease. We report two cases of AHS in patients who were taking thiazide medication due to hypertension and underlying renal disease. They developed an erythematous skin rash, fever, renal dysfunction, and eosinophilia after allopurionol therapy.

Two Cases of Allopurinol Hypersensitivity Syndrome due to Use of Allopurinol for the Patient with Asymptomatic Hyperuricemia / 대한피부과학회지

Allopurinol (4-hydroxypyrazolo[3, 4-d]pyrimidine) is a xanthine oxidase inhibitor and is widely used in the treatment of hyperuricemia. Allopurinol hypersensitivity syndrome (AHS) includes a prolonged illness initially manifested by fever, a prominent cutaneous reaction, eosinophilia, hepatic abnormalities, and decreased renal function. Two patients in our study had a decreased renal function; one due to bilateral polycystic kidneys and the other due to bilateral ureteral stones. Both had received allopurinol for asymptomatic hyperuricemia. Whilst taking this medication, they showed a generalized erythematous, maculopapular eruption with fever, leukocytosis, eosinophilia, a further decrease of renal function and prolonged severe hepatic abnormalities. One patient showed an improvement after they stopped taking allopurinol and were treated with steroids, however, died, due to combined giant cell pneumonia. However, the other patient did improve when they stopped taking allopurinol.

Two Cases of Allopurinol hypersensitivity syndrome / 대한피부과학회지

Allopurinol hypersensitivity syndrome typically occurs in persons with preexisting renal failure, weeks to months after allopurinol is begun, the patient develops a generalized rash that often evolves to exfoliative erythroderma. Associated with the dermatitis is fever, leukocytosis, hepatitis, typically worsening of renal function. Two patients developed erythematous skin rash one month and 15 days, respectively, after allopurinol therapy. They were treated with high dose prednisolone for three weeks, but one patient died to pneumonia and sepsis, and the other patient improved and followed up.

A Case of Allopurinol Hypersensitivity Syndrome / 대한피부과학회지

Allopurinol(4-hydroxypyrazolo[3, 4-d]pyrimidine) is an analog of hypoxanthine, widely used in the treatment of gout and in some patients develop the allopurinol hypersensitivity syndrome. Allopurinol hypersensitivity syndrome is characterized by multiple symptoms and signs such as fever, rash, decreased renal function, hepatocellular injury, leukocytosis, and eosinophilia. Herein reported is a 44 year-old male patient who developed generalized erythematous skin eruption with severe hepatotoxicity 3 weeks after taking allopurinol medication. The patient improved by dropping the allopurinol medication, which was consistent with the allopurinol hypersensitivity syndrome.

A Case of Allopurinol Hypersensitivity Syndrome

Allopurinol is a xanthine oxidase inhibitor widely used to control plasma uric acid levels. Serious and life threatening adverse effects such as the allopurinol hypersensitivity syndrome(AHS) are rare. We describe a 32-year-old female patient who was treated with allopurinol and developed fever, rash, and renal and liver dysfunction.

Three Cases of Allopurinol Hypersensitivity Syndrome / 대한피부과학회지

The allopurinol hypersensicivity syndrome is a rare, but life thereaning immunologic reaction of allopurinol therapy, characterized by multiple abnormalities such as fever, rash, decreased renal function, hepatocellular injury, leukocytosis, and eosinophila. It may require prolonged hospitalization and occasionally involves residual morbidity. Three patients developed erythematous skin eruption three to five weeks after beginning therapy with allopurinol. The clinical, laboratory, and histologic findings of these patients were compatible with a allopurinol hyperensitivity syndrome.