Lamotrigine induced DIHS/DRESS: Manifestations, treatment, and outcome in 57 patients

Wang, Xiang-qing; Lv, Bin; Wang, Hong-fen; Zhang, Xu; Yu, Shengyuan; Huang, Xusheng; Zhang, Jiatang; Tian, Chenglin; Lang, Sen-yang

doi:10.1016/j.clineuro.2015.07.008

Cited by 23 publications

(23 citation statements)

References 53 publications

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“…Based on ICH guidelines, enhancement of the immune response can exaggerate hypersensitivity reactions (2). In this context, previous case reports described DTH reaction after treatment with lamotrigine as cases of lamotrigine-induced DRESS (15), where DRESS was defined as a type of cell-mediated immune stimulation (DTH reaction) (23). Therefore, the results of the current study support the notion that lamotrigine can enhance cellular immune responses and can exaggerate DTH reactions.…”

Section: Effects Of Lamotrigine On Immune System Parameters In Vivosupporting

confidence: 77%

“…This is also due to its effects on the immune system, as described before, in patients with epilepsy where these effects could be of therapeutic benefit (14)(15)(16). Considering its adverse effects, a black box warning was introduced into the monograph of this drug in 2010 owing to the serious hypersensitivity adverse effects that have occurred with lamotrigine treatment such as SJS, DRESS, and drug-induced hypersensitivity syndrome (14,15). With regard to its immunomodulatory effects in epilepsy, low levels of immunoglobulins have been observed in the sera of epileptic patients treated with lamotrigine (16).…”

mentioning

confidence: 99%

“…Evaluation of the immunomodulatory effects of lamotrigine has become pivotal due to its allergic and hypersensitivity adverse effects. This is also due to its effects on the immune system, as described before, in patients with epilepsy where these effects could be of therapeutic benefit (14)(15)(16). Considering its adverse effects, a black box warning was introduced into the monograph of this drug in 2010 owing to the serious hypersensitivity adverse effects that have occurred with lamotrigine treatment such as SJS, DRESS, and drug-induced hypersensitivity syndrome (14,15).…”

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confidence: 99%

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Evaluation of immunomodulatory effects of lamotrigine in BALB/c mice

et al. 2017

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Modulation of the immune system has recently been shown to be involved in the pharmacological effects of old antiepileptic drugs and in the pathogenesis of epilepsy. Therefore, the most recent guidelines for immunotoxicological evaluation of drugs were consulted to investigate the immunomodulatory effects of lamotrigine, a newer antiepileptic drug, in BALB/c mice. These included the in vivo effects of lamotrigine on delayed-type hypersensitivity (DTH) response to sheep red blood cell (SRBC) antigens, hemagglutination titer assays and hematological changes. In vitro effects of lamotrigine on ConA-induced splenocyte proliferation and cytokine secretion were assessed. The results showed that lamotrigine treatment significantly increased the DTH response to SRBC in the mouse model of this study. This was accompanied by a significant increase in relative monocyte and neutrophil counts and in spleen cellularity. Lamotrigine significantly inhibited ConA-induced splenocyte proliferation in vitro and it significantly inhibited IL-2 and TNF-α secretion in ConA-stimulated splenocytes. In conclusion, the results demonstrated significant immunomodulatory effects of lamotrigine in BALB/c mice. These data could expand the understanding of lamotrigine-induced adverse reactions and its role in modulating the immune system in epilepsy.

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Section: Effects Of Lamotrigine On Immune System Parameters In Vivosupporting

confidence: 77%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of immunomodulatory effects of lamotrigine in BALB/c mice

et al. 2017

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“…After the laboratory results were ascertained, DRESS syndrome was finally diagnosed, and systemic steroid administration was started. Although it is known that the initial symptoms of the syndrome are usually a skin rash with fever1013, as in our case, it may start as a simple drug eruption and then systemic symptoms may be detected later. Therefore, caution is required when making a diagnosis.…”

Section: Discussionmentioning

confidence: 69%

“…We reviewed a report that analyzed clinical data from 37 published reports with 57 cases diagnosed with DRESS syndrome or drug-induced hypersensitivity syndrome (DIHS) related to lamotrigine therapy. The cases were collected from published papers in PubMed and the Scopus database (from January 1999 to April 2014)13. In Korea, two cases of severe drug eruptions associated with lamotrigine treatment have been reported.…”

Section: Discussionmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptom Syndrome Induced by Lamotrigine

et al. 2017

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Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a type of severe adverse drug-induced reaction. Dermatologists should make a quick diagnosis and provide appropriate treatment for DRESS syndrome to reduce mortality rates, which can be as high as 10%. We present the case of a 47-year-old man with schizoaffective disorder treated with lamotrigine who developed DRESS syndrome to emphasize the importance of close observation of patients with drug eruption. He was consulted for erythematous maculopapular rashes on the trunk that developed 3 weeks after starting lamotrigine. A few days later, he developed generalized influenza-like symptoms. The skin rashes spread over his entire body, and the sense of itching was rapidly aggravated within a few days. Increased liver enzyme levels and significant eosinophilia were found on laboratory test results. His condition was diagnosed as DRESS syndrome, and he was treated with systemic and topical corticosteroids for 2 weeks.

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