Allopurinol Hypersensitivity Syndrome: A Review
- 1 March 1993
- journal article
- review article
- Published by SAGE Publications in Annals of Pharmacotherapy
- Vol. 27 (3), 337-343
- https://doi.org/10.1177/106002809302700317
Abstract
OBJECTIVE: To review the pathophysiology, pathology, and clinical findings of allopurinol hypersensitivity syndrome (AHS), an infrequent but life-threatening adverse effect of allopurinol therapy. DATA SOURCES: A MEDLINE search (key terms hepatitis, interstitial nephritis, severe hypersensitivity, severe toxicity, vasculitis, toxic epidermal necrolysis, Lyell's syndrome, erythema multiforme, and Stevens-Johnson syndrome) was used to identify cases reported in the literature through the end of 1990. STUDY SELECTION: All cases evaluated met Singer and Wallace's diagnostic criteria for AHS. DATA EXTRACTION: We extracted data from 101 cases of AHS reported in the literature. The following information, when available, was analyzed: (1) patient data (age, gender, medical history), (2) treatment data (daily dosage of allopurinol, duration of treatment, indications, concomitant medications, and (3) adverse-event data. DATA SYNTHESIS: Patients were mostly middle-aged men with hypertension and/or renal failure receiving excessive doses of allopurinol primarily for asymptomatic hyperuricemia. Cutaneous rash and fever were the most common clinical findings. CONCLUSIONS: Although the pathophysiologic pathway leading to the development of AHS is unknown, it probably involves an immunologic mechanism following allopurinol accumulation in patients with poor renal function. Our findings suggest that the accepted diagnostic criteria for AHS may be too broad, and we recommend the application of more restrictive criteria. There is no effective treatment for AHS. The use of allopurinol only for accepted indications and in dosages adjusted for a patient's renal function may be the only means of minimizing the incidence of AHS.Keywords
This publication has 40 references indexed in Scilit:
- Asymptomatic hyperuricaemia and allopurinol induced toxic epidermal necrolysis.BMJ, 1985
- Severe allopurinol toxicityAmerican Journal Of Medicine, 1984
- Acute adverse reactions attributed to allopurinol in hospitalised patients.Annals Of The Rheumatic Diseases, 1981
- Systemic Hypersensitivity to Allopurinol with Acute Interstitial NephritisAmerican Journal of Nephrology, 1981
- Allopurinol hypersensitivity.BMJ, 1979
- ALLOPURINOL-ASSOCIATED ARTERITISThe Lancet, 1976
- Allopurinol hypersensitivityAmerican Journal Of Medicine, 1976
- Severe Allopurinol HypersensitivityArchives of Internal Medicine, 1974
- Toxic Epidermal Necrolysis, Azotemia, and Death After Allopurinol TherapyPublished by American Medical Association (AMA) ,1970
- Vasculitis with allopurinol therapyAmerican Heart Journal, 1970