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Related Experiment Videos

Anticonvulsant drug hypersensitivity.

Pedro A Galindo1, Jesús Borja, Elisa Gómez

  • 1Allergy Section, Hospital Complex, Ciudad Real, Spain. pgb01cr@saludalia.es

Journal of Investigational Allergology & Clinical Immunology
|August 21, 2003
PubMed
Summary

Anticonvulsant drugs can cause severe skin reactions like rashes and fever. Patch tests help diagnose this hypersensitivity, with carbamazepine and phenytoin being common culprits. Sodium valproate is often well-tolerated.

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Area of Science:

  • Dermatology
  • Allergology
  • Pharmacology

Background:

  • Cutaneous adverse reactions are common with anticonvulsant drugs, particularly aromatic ones like carbamazepine, phenytoin, and phenobarbital.
  • Hypersensitivity to multiple anticonvulsants is frequent yet unpredictable.
  • Patch testing is a valuable diagnostic tool for these reactions.

Purpose of the Study:

  • To investigate the clinical presentation, responsible drugs, and diagnostic methods for anticonvulsant-induced skin allergies.
  • To evaluate the utility of patch tests and skin biopsies in diagnosing anticonvulsant hypersensitivity syndrome.
  • To identify frequently implicated and tolerated anticonvulsant medications.

Main Methods:

  • A study of 15 patients with anticonvulsant skin allergy.

Related Experiment Videos

  • Analysis of analytical alterations, causative drugs, and tolerated anticonvulsants.
  • Performance of patch tests with anticonvulsant drugs (5% pet. and aq.) and skin biopsies where indicated.

    • Main Results:

    • 15 patients experienced 23 adverse skin reactions, most commonly fever with generalized rash.
    • Eosinophilia and elevated liver enzymes were observed in several cases.
    • Carbamazepine and phenytoin were the most frequent culprits; sodium valproate and topiramate were often tolerated.
    • 12 positive patch tests were recorded, with carbamazepine and phenytoin showing the highest positivity.
    • Skin biopsies revealed findings consistent with erythema multiforme or leucocytoclastic angitis.

    Conclusions:

    • Anticonvulsant hypersensitivity syndrome often presents as rash with fever, associated with eosinophilia and elevated liver enzymes.
    • Carbamazepine and phenytoin are frequently implicated drugs.
    • Patch tests are effective in diagnosing anticonvulsant hypersensitivity.
    • Sodium valproate was the best-tolerated drug, though cross-reactivity can occur.
    • Erythema multiforme is a common finding in skin biopsies.