PMID- 21393610
OWN - NLM
STAT- MEDLINE
DCOM- 20120530
LR  - 20151119
IS  - 1460-2385 (Electronic)
IS  - 0931-0509 (Linking)
VI  - 26
IP  - 11
DP  - 2011 Nov
TI  - HLA-B58 can help the clinical decision on starting allopurinol in patients with 
      chronic renal insufficiency.
PG  - 3567-72
LID - 10.1093/ndt/gfr060 [doi]
AB  - BACKGROUND: Although allopurinol is a very effective urate-lowering drug for 
      complicated hyperuricemia, in some patients, it can induce severe cutaneous 
      adverse reactions (SCARs). Recent investigations suggest that HLA-B*5801 is a 
      very strong marker for allopurinol-induced SCARs, especially in the population 
      with a high frequency of HLA-B*5801. Korea is one of the countries with a high 
      frequency of HLA-B*5801 which is the only subtype of HLA-B58 in the Korean 
      population. Objective. This study was conducted to find out the incidence of 
      allopurinol-induced hypersensitivity on patients with chronic renal insufficiency 
      (CRI) according to HLA-B58 and the clinical implications of HLA-B58 as a risk 
      marker for the development of allopurinol-induced hypersensitivity. METHODS: We 
      retrospectively reviewed the medical records of patients with CRI who took 
      allopurinol and carried out serologic human leukocyte antigen (HLA) typing for 
      kidney transplantation between January 2003 and May 2010. RESULTS: Among a total 
      of 448 patients with CRI, 16 (3.6%) patients experienced allopurinol 
      hypersensitivity. Nine of these patients (2.0%) were diagnosed with SCARs (two 
      Stevens-Johnson syndrome and seven allopurinol hypersensitivity syndrome) and 
      seven patients (1.6%) had simple maculopapular rashes. The HLA-B58 allele was 
      present in all patients with allopurinol-induced SCARs, while the frequency of 
      HLA-B58 was only 9.5% in allopurinol-tolerant patients (P < 0.05). The incidence 
      of allopurinol-induced SCARs in CRI shows a wide disparity according to HLA-B58 
      [18% in HLA-B58 (+) versus 0% in HLA-B58 (-)]. Among patients without HLA-B58, 
      most (98.2%) of the CRI patients were tolerant to allopurinol and only 1.8% 
      experienced simple rashes after taking allopurinol. CONCLUSIONS: In this study, 
      the incidence of allopurinol-induced SCARs was considerably high in CRI patients 
      with HLA-B58. This finding indicates that the presence of HLA-B58 may increase 
      the risk of allopurinol-induced SCARs. Screening tests for HLA-B58 in CRI 
      patients will be clinically helpful in preventing severe allopurinol 
      hypersensitivity reactions.
FAU - Jung, Jae-Woo
AU  - Jung JW
AD  - Department of Internal Medicine, Seoul National University College of Medicine, 
      Seoul, Korea.
FAU - Song, Woo-Jung
AU  - Song WJ
FAU - Kim, Yon-Su
AU  - Kim YS
FAU - Joo, Kwon Wook
AU  - Joo KW
FAU - Lee, Kyung Wha
AU  - Lee KW
FAU - Kim, Sae-Hoon
AU  - Kim SH
FAU - Park, Heung-Woo
AU  - Park HW
FAU - Chang, Yoon-Seok
AU  - Chang YS
FAU - Cho, Sang-Heon
AU  - Cho SH
FAU - Min, Kyung-Up
AU  - Min KU
FAU - Kang, Hye-Ryun
AU  - Kang HR
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110310
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Biomarkers)
RN  - 0 (Gout Suppressants)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-B58)
RN  - 63CZ7GJN5I (Allopurinol)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Allopurinol/*adverse effects
MH  - Biomarkers/*metabolism
MH  - Drug Hypersensitivity/*diagnosis/metabolism
MH  - Female
MH  - Follow-Up Studies
MH  - Gout Suppressants/*adverse effects
MH  - HLA-B Antigens/*metabolism
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Renal Insufficiency, Chronic/*drug therapy
MH  - Republic of Korea
MH  - Retrospective Studies
MH  - Stevens-Johnson Syndrome/chemically induced/*diagnosis/metabolism
MH  - Young Adult
EDAT- 2011/03/12 06:00
MHDA- 2012/05/31 06:00
CRDT- 2011/03/12 06:00
PHST- 2011/03/12 06:00 [entrez]
PHST- 2011/03/12 06:00 [pubmed]
PHST- 2012/05/31 06:00 [medline]
AID - gfr060 [pii]
AID - 10.1093/ndt/gfr060 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2011 Nov;26(11):3567-72. doi: 10.1093/ndt/gfr060. Epub 
      2011 Mar 10.