Allopurinol induced severe cutaneous adverse reactions: Vigilance of prescription (31 cases)

• Published in: Revue française d'allergologie (2009) 2023-03, Vol.63 (2), p.103275, Article 103275
• Main Authors: Hali, F., Chagraoui, H., Meftah, A., Marnissi, F., Chaabi, S., Chiheb, S., Filali, H.
• Format: Article
• Language: English
• Subjects: Allopurinol; Complications viscérales; Prevention; Pronostic vital; Prévention; Severe cutaneous adverse reactions; Toxidermies graves; Visceral complication; Vital prognosis
• ISSN: 1877-0320; 1877-0320
• DOI: 10.1016/j.reval.2022.103275

Allopurinol is a hypouricemic drug that has been prescribed since 1963. It is one of the most common drugs that induce Severe Cutaneous Adverse Reactions (SCARs), namely Stevens Johnson syndrome (SJS)/Lyell syndrome (LS) and DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). In our hospital series, we report cases of SCARs attributed to allopurinol in order to sensitize prescribers to the risk of its misuse. We carried out a retrospective study from 2011 to 2021 of patients hospitalized at our dermatology department for SCARs induced by allopurinol. Imputability was confirmed by the French methodology of Bégaud et al. We identified 31 cases. The median age was 63 years (26–83). The sex-ratio (M/F) was 0.34. Twenty-two point five percent of patients were being followed for chronic renal disease. Allopurinol was prescribed in 77.4% cases for laboratory indications of asymptomatic hyperuricemia. Combined use with a thiazide diuretic was found in 51.6% of patients. The clinical forms were: 21 DRESS syndrome, 5 LS, 2 overlap syndrome and 3 SJS. The median time to onset of clinical signs was 4 days to 5 weeks for SJS/LS and 2 to 8 weeks for DRESS. Complications were as follows: renal failure (48.3%), hepatic cytolysis (51.6%), electrolyte imbalance in (54.8%), severe sepsis (16.6%) and corneal ulcer (6.4%). Major hypereosinophilia was noted in 48.3% of cases and was significantly associated with hepatic cytolysis (P=0.014). Five patients required a stay in the intensive care unit, with death occurring in 12.9%. Despite its capacity to cause life-threatening SCARs, allopurinol continues to be prescribed in most cases of asymptomatic hyperuricemia. Such misuse in terms of indication and follow-up warrants the raising of physicians’ awareness concerning the benefit/risk ratio. L’allopurinol est un hypo-uricémiant pourvoyeur de toxidermies graves parfois mortelles à savoir le syndrome de Stevens Johnson (SSJ)/Lyell (SL) et le DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome. Nous rapportons à travers notre série hospitalière les effets indésirables graves cutanés et viscéraux imputés à l’allopurinol afin de sensibiliser les prescripteurs au risque de son mésusage. Étude rétrospective allant de 2011 à 2021 des patients hospitalisés pour toxidermie grave causée par l’allopurinol dans notre département de dermatologie. L’imputabilité à l’allopurinol était confirmée par la méthodologie française de Bégaud et al. Nous avons recensé 31 ca