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The allopurinol hypersensitivity syndrome.

G P Lupton, R B Odom

    Journal of the American Academy of Dermatology
    |October 1, 1979
    PubMed
    Summary

    Allopurinol hypersensitivity reactions are increasing, causing significant mortality, especially in patients with renal disease. Proper dosing and awareness are crucial for managing this severe drug reaction.

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    Area of Science:

    • Pharmacology
    • Nephrology
    • Immunology

    Background:

    • Allopurinol is frequently prescribed for hyperuricemia.
    • Hypersensitivity reactions to allopurinol are increasingly reported.
    • These reactions can be severe and potentially fatal.

    Observation:

    • A review of 38 patients revealed 10 deaths (26%) due to allopurinol hypersensitivity.
    • Most patients had pre-existing renal disease, often with unadjusted allopurinol dosages.
    • Many patients were on thiazide diuretics and received allopurinol for asymptomatic hyperuricemia.

    Findings:

    • Hallmarks include prolonged fever, rash, eosinophilia, liver issues, and acute kidney injury.
    • Gastrointestinal bleeding is a common complication.
    • The reaction may involve immune complexes with an unknown antigen.

    Implications:

    • This hypersensitivity syndrome necessitates prolonged corticosteroid treatment.
    • Careful patient selection, dosage adjustment in renal impairment, and monitoring are vital.
    • Increased awareness is needed to prevent severe outcomes from allopurinol hypersensitivity.

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