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Allopurinol hypersensitivity syndrome

S S Lee1, H Y Lin, S R Wang

  • 1Department of Internal Medicine, Veterans General Hospital, Taipei, Taiwan, R.O.C.

Zhonghua Minguo Wei Sheng Wu Ji Mian Yi Xue Za Zhi = Chinese Journal of Microbiology and Immunology
|August 1, 1994
PubMed
Summary
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Allopurinol hypersensitivity syndrome (AHS) is a severe reaction to allopurinol. Limiting its use to accepted indications and adjusting dosage for renal function are key to minimizing AHS incidence and mortality.

Area of Science:

  • Pharmacovigilance
  • Clinical Toxicology
  • Internal Medicine

Background:

  • Allopurinol hypersensitivity syndrome (AHS) is a rare but severe adverse drug reaction.
  • It presents with a spectrum of symptoms including fever, rash, and organ dysfunction.

Purpose of the Study:

  • To review the clinical characteristics, outcomes, and mortality factors of AHS.
  • To identify strategies for minimizing AHS incidence.

Main Methods:

  • Retrospective review of 38 patients diagnosed with AHS.
  • Analysis of clinical presentations, laboratory findings, and treatment outcomes.

Main Results:

  • Fever, rash, leukocytosis, eosinophilia, renal impairment, and hepatocellular injury were common. Mortality was 24%, with infection as the leading cause of death.

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  • Toxic epidermal necrolysis (TEN) was significantly associated with increased mortality (p < 0.001).
  • Corticosteroid use did not improve survival rates. 26% of patients received allopurinol for asymptomatic hyperuricemia, an unapproved indication.

    • Conclusions:

    • Minimizing AHS incidence requires restricting allopurinol therapy to established indications and adjusting dosage based on renal function.
    • Early recognition and management are crucial, though effective treatments remain limited.
    • Avoiding allopurinol for asymptomatic hyperuricemia is recommended.