Anticonvulsant hypersensitivity syndrome: cross-reactivity with tricyclic antidepressant agents

Seitz, Cornelia S.; Pfeuffer, Petra; Raith, Petra; Bröcker, Eva B.; Trautmann, Axel

doi:10.1016/s1081-1206(10)61103-9

Cited by 45 publications

(35 citation statements)

References 27 publications

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“…33,[59][60][61][62][63][64] In the present work, we observed cross-reactivity between LTG and CBZ. The phenomenon may be explained by the ability of T-cells to recognize the major histocompatibility complex (MHC) of a drug-MHC complex.…”

Section: Discussionsupporting

confidence: 66%

Genetic and immune predictors for hypersensitivity syndrome to antiepileptic drugs

Neuman

Cohen

Nanau

et al. 2012

Translational Research

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Section: Discussionsupporting

confidence: 66%

Genetic and immune predictors for hypersensitivity syndrome to antiepileptic drugs

Neuman

Cohen

Nanau

et al. 2012

Translational Research

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“…HHV6, Epstein-Barr virus, and cytomegalovirus reactivations can be found in many patients 2-4 weeks after the onset of DRESS [17,20,26,27], but these have not been described in patients with severe exanthema alone, who account for many of the patients with MDH. This, as well as the delayed appearance of herpes virus reactivations in DRESS, suggests that these viral reactivations are not necessary to start an MDH syndrome.…”

Section: Clinical Characteristics Of Mdhmentioning

confidence: 99%

Multiple Drug Hypersensitivity

Pichler

Srinoulprasert²,

Yun³

et al. 2017

Int Arch Allergy Immunol

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Multiple drug hypersensitivity (MDH) is a syndrome that develops as a consequence of massive T-cell stimulations and is characterized by long-lasting drug hypersensitivity reactions (DHR) to different drugs. The initial symptoms are mostly severe exanthems or drug rash with eosinophilia and systemic symptoms (DRESS). Subsequent symptoms due to another drug often appear in the following weeks, overlapping with the first DHR, or months to years later after resolution of the initial presentation. The second DHR includes exanthema, erythroderma, DRESS, Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), hepatitis, and agranulocytosis. The eliciting drugs can be identified by positive skin or in vitro tests. The drugs involved in starting the MDH are the same as for DRESS, and they are usually given in rather high doses. Fixed drug combination therapies like sulfamethoxazole/trimethoprim or piperacillin/tazobactam are frequently involved in MDH, and 30-40% of patients with severe DHR to combination therapy show T-cell reactions to both components. The drug-induced T-cell stimulation appears to be due to the p-i mechanism. Importantly, a permanent T-cell activation characterized by PD-1+/CD38+ expression on CD4+/CD25^low T cells can be found in the circulation of patients with MDH for many years. In conclusion, MDH is a drug-elicited syndrome characterized by a long-lasting hyperresponsiveness to multiple, structurally unrelated drugs with clinically diverse symptoms.

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“…Non-AA antiepileptic medications were presumed safe. 7 Our case suggested that even though AA medications have a much lower likelihood of producing AHS, they do still pose a real, palpable risk for patients. In addition, medical professionals must remain alert regarding the potential of crossreactivity between AA and non-AA medications.…”

Section: Discussionmentioning

confidence: 73%

“…Seitz et al 7 suggested that there is a cross-reactivity between AAs and tricyclic antidepressants. Because cross-reactivity can be as high as 75%, they recommended that physicians be taught not to use these agents in such situations, but to instead use VPA, benzodiazepine, lamotrigine, and gabapentin.…”

Section: Introductionmentioning

confidence: 99%

Acute Hypersensitivity Syndrome Caused by Valproic Acid: A Review of the Literature and a Case Report

Bota¹,

Ligasan²,

Najdowski³

et al. 2011

TPJ

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Anticonvulsant hypersensitivity syndrome: cross-reactivity with tricyclic antidepressant agents

Cited by 45 publications

References 27 publications

Genetic and immune predictors for hypersensitivity syndrome to antiepileptic drugs

Genetic and immune predictors for hypersensitivity syndrome to antiepileptic drugs

Multiple Drug Hypersensitivity

Acute Hypersensitivity Syndrome Caused by Valproic Acid: A Review of the Literature and a Case Report

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