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Cross-sensitivity and the anticonvulsant hypersensitivity syndrome
D M Moss1, M Rudis, S O Henderson
1Department of Emergency Medicine, University of Southern California School of Medicine, Los Angeles, USA.
The Journal of Emergency Medicine
|May 25, 1999
Summary
Anticonvulsant hypersensitivity syndrome is a rare reaction to antiepileptic drugs. Cross-sensitivity exists among drugs metabolized via arene oxides, necessitating careful recognition.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Anticonvulsant hypersensitivity syndrome (AHS) is a rare, severe adverse drug reaction.
- It is associated with specific antiepileptic medications, most commonly phenytoin.
Observation:
- This case highlights AHS, emphasizing its diverse clinical presentations.
- Familial occurrence of AHS has been previously documented.
Findings:
- Carbamazepine and phenobarbital, like phenytoin, can trigger AHS.
- Cross-reactivity is observed among anticonvulsants sharing the arene oxide metabolic pathway.
Implications:
- Early recognition of AHS is crucial for patient management.
- Awareness of cross-sensitivity can guide safer medication choices in susceptible individuals.
Related Concept Videos
00:42Cross-reactivity
Overview
01:30Hypersensitivities
Hypersensitivity, also known as a hypersensitivity reaction or allergic reaction, is a condition where the body's immune system reacts abnormally to a foreign substance. Such substances, that cause hypersensitivity are referred to as an allergen, could be something typically harmless to most people, like pollen or certain foods.
Types of Hypersensitivities
Hypersensitivity reactions are categorized into four types: Type 1, Type 2, Type 3, and Type 4. Each type has a distinct mechanism...
Types of Hypersensitivities
Hypersensitivity reactions are categorized into four types: Type 1, Type 2, Type 3, and Type 4. Each type has a distinct mechanism...
01:30Drug Toxicity: Allergic Reactions
Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial exposure to a...
01:01Hypersensitivity Reactions: Cytolytic Reactions
Type II hypersensitivity involves IgG and IgM antibodies targeting cell surface antigens, leading to cell destruction. This can occur through complement activation, antibody-dependent cell-mediated cytotoxicity (ADCC), or acting as opsonins for phagocytosis. When excessive, these reactions cause significant tissue damage.Drug-induced hemolytic anemia is a common example, where drugs like penicillin or cephalosporins bind to red blood cells, forming drug-protein complexes. These complexes...
01:30Drug toxicity: Drug–Drug Interaction
Drug–drug interactions can precipitate toxicity through multiple mechanisms. Absorption interactions alter how drugs enter the body, exemplified when ranitidine increases the absorption of basic drugs, while cholestyramine decreases the levels of propranolol. Protein binding interactions occur when drugs share the same binding sites on plasma proteins. Drugs like aspirin and warfarin, when bound in excess, can lead to increased free drug concentrations, enhancing the potential for...
01:19Hypersensitivity Reactions: Immune-Complex Reactions
Type III hypersensitivity reactions occur when antigen–antibody complexes form and activate the complement system. Normally, these complexes help the clearance of antigens by phagocytes and red blood cells. However, when large numbers of immune complexes are present, they can deposit in tissues—particularly in the walls of blood vessels—leading to inflammation and tissue injury. These deposits trigger complement activation and neutrophil recruitment, resulting in serum sickness, a systemic...