Anticonvulsant hypersensitivity syndrome

Kaminsky, A; Moreno, Maria Cecilia Rey; Díaz, Mariángeles; Charas, V.; Bravo, Gary; Kien, Christina

doi:10.1111/j.1365-4632.2004.02233.x

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…2 We reviewed 18 cases that were published in English and readily obtainable, including four cases published before 2004. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Among these cases, fever and rash occurred in 100% of patients. Maculopapular rashes as a specific type of rash, elevated transaminase levels, and eosinophilia were the next most common findings (Table 1).…”

Section: Clinical Manifestationmentioning

confidence: 99%

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Anticonvulsant Hypersensitivity Syndrome: Implications for Pharmaceutical Care

2007

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Anticonvulsant hypersensitivity syndrome (AHS) is a delayed adverse drug reaction associated with the use of aromatic anticonvulsant drugs. It has been most commonly reported with the use of phenytoin, carbamazepine, and phenobarbital. Although its occurrence is rare, 1 in every 1000-10,000 exposures, AHS is a serious adverse event often resulting in hospitalization and even death. The clinical manifestations of AHS include a triad of symptoms consisting of dermatologic rashes, fever, and evidence of systemic organ involvement. Diagnosis is most frequently based on the recognition of this triad of symptoms and clinical judgment. The exact mechanism of AHS remains to be determined but is thought to have at least three components: deficiency or abnormality of the epoxide hydroxylase enzyme that detoxifies the metabolites of aromatic amine anticonvulsants, associated reactivation of herpes-type viruses, and ethnic predisposition with certain human leukocyte antigen subtypes. Arene oxides, the toxic intermediaries in the metabolism of anticonvulsant drugs, can accumulate and directly bind to macromolecules, causing cell death, as well as act as prohaptens that bind to T cells, initiating an immune response and systemic reactions. Management of AHS primarily includes discontinuation of the associated anticonvulsant drug. Systemic corticosteroids are usually required for full recovery. An important issue regarding AHS is the cross-sensitivity among aromatic anticonvulsant drugs, which has been reported to be 40-80%. This means that patients with a history of AHS should avoid further use of any aromatic anticonvulsant drug. In addition, a familial association with AHS exists, and family members of the patient with AHS should be educated that they may be at increased risk for developing AHS if they use aromatic anticonvulsant drugs. Anticonvulsant drugs that are generally considered safe are valproic acid and benzodiazepines. Other nonaromatic anticonvulsant drugs should also be acceptable. Pharmacists as health care providers can play an important role in the diagnosis, treatment, and prevention of AHS.

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Section: Clinical Manifestationmentioning

confidence: 99%

“…This was clearly evident in the review of 18 cases, where four patients had documented worsening of AHS when steroids were discontinued prematurely. 28,31,32,37 Antihistamines may also be used, but the evidence supporting benefit is lacking. The adjunct use of intravenous immunoglobulin is controversial.…”

Section: Treatmentmentioning

confidence: 99%

Anticonvulsant Hypersensitivity Syndrome: Implications for Pharmaceutical Care

2007

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“…Relapse can occur during the tapering of glucocorticoids. [10] Successful use of i.v. immuneglobulin in nevirapine-induced DRESS syndrome has been reported,[11] as well as N -acetylcysteine in a patient with sulfasalazine-induced DRESS syndrome.…”

Section: Discussionmentioning

confidence: 99%

Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum

et al. 2011

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Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome reflects a serious hypersensitivity reaction to drugs, and is characterized by skin rash, fever, lymph node enlargement, and internal organ involvement. So far, numerous drugs such as sulfonamides, phenobarbital, sulfasalazine, carbamazepine, and phenytoin have been reported to cause DRESS syndrome. We report a case of a 10-year-old girl who developed clinical manifestations of fever, rash, lymphadenopathy, hypereosinophilia, and visceral involvement (hepatitis and pneumonitis) after taking phenobarbital for seizures, with subsequent development of sepsis, acute respiratory distress syndrome (ARDS) and spontaneous air leak syndrome (pnemothorax and pneumomediastinum). She was put on steroids and various antibiotics and was ventilated, but ultimately succumbed to sepsis and pulmonary complications.

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“…The abrupt discontinuation of anticonvulsants in patients with epilepsy may be associated with worsening of seizure control and should be performed in a hospital setting. Alternative anticonvulsant therapy can be substituted in most cases with valproate, benzodiazepines, gabapentin, or vigabatrin, depending on the primary disorder 41 . To treat the symptoms of DRESS syndrome, topical and oral or parenteral corticosteroids, antihistamines, and the maintenance of fluid and electrolyte balance have all been shown to be beneficial.…”

Section: Introductionmentioning

confidence: 99%

“…Alternative anticonvulsant therapy can be substituted in most cases with valproate, benzodiazepines, gabapentin, or vigabatrin, depending on the primary disorder. 41 To treat the symptoms of DRESS syndrome, topical and oral or parenteral corticosteroids, antihistamines, and the maintenance of fluid and electrolyte balance have all been shown to be beneficial. Systemic corticosteroids are often used, although there have been no controlled clinical trials to assess the efficacy of this treatment.…”

Section: Introductionmentioning

confidence: 99%

Carbamazepine‐induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: report of four cases and brief review

Ganeva¹,

et al. 2008

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe drug reaction, most commonly to aromatic anticonvulsants with a delayed onset, variable clinical presentation and protracted course. The exact incidence of DRESS syndrome is not known because of the variability in clinical presentation, lack of strict diagnostic criteria and universally accepted nomenclature. We report four cases of DRESS syndrome associated with the use of carbamazepine. The clinical manifestation was similar: a maculopapular eruption progressing to exfoliative erythroderma, fever, and lymphadenopathy. Leukocytosis, atypical lymphocytes and liver injury (in 2 patients) were also observed. Assessment of causality using the Naranjo algorithm established a "probable" relationship with carbamazepine in three of the cases and a "possible" relationship in one case. Detection of DRESS syndrome is dependent on the exclusion of a variety of diseases with similar manifestations and may be delayed in time. DRESS syndrome is a potentially life-threatening multisystem adverse drug reaction, and accidental reexposure or drug provocation tests must be avoided.

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Anticonvulsant hypersensitivity syndrome

Cited by 16 publications

References 18 publications

Anticonvulsant Hypersensitivity Syndrome: Implications for Pharmaceutical Care

Anticonvulsant Hypersensitivity Syndrome: Implications for Pharmaceutical Care

Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum

Carbamazepine‐induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: report of four cases and brief review

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