Hypersensitivity syndrome carbamazepine

Barbiturates, carbamazepine, and phenytoin (antiepileptic hypersensitivity syndrome)... 

Deficiency of epoxide hydrolase Phenytoin, carbamazepine, phenobarbital Life threatening hypersensitivity syndrome due to accumulation of toxic intermediates... 

Within 5 days of being switched to valproate after developing a rash ascribed to carbamazepine, a 55-year-old man developed anticonvulsant hypersensitivity syndrome (maculopapular rash, fever, hepatitis, and eosinophilia) and ocular manifestations consistent with bilateral anterior uveitis (136). 

A report of two cases has suggested that carbamazepine can cause colitis as part of the anticonvulsant hypersensitivity syndrome (48). 

The carbamazepine hypersensitivity syndrome has been reviewed (68). Some of the following cases are examples of the different manifestations of this syndrome. 

Elstner S, Sperling W. Das Carbamazepin-Hypersensitivitats-Syndrome. Differentialdiagnostische Erwagungen an einer exemplarischen FaUvorstellungo. [The carbamazepine hypersensitivity syndrome. Differential diagnosis and a representative case history.] Fortschr Neurol Psychiatr 2000 68(4) 188-92. 

Koga T, Kubota Y, Nakayama J. Interferon-gamma production in the peripheral lymphocytes of a patient with carbamazepine hypersensitivity syndrome. Acta Dermatol Venereol 2000 80(1) 73. 

Verrotti A, Feliciani C, Morresi S, Coscione G, Morgese G, Toto P, Chiarelli F. Carbamazepine-induced hypersensitivity syndrome in a child with epilepsy. Int J Immunopathol Pharmacol 2000 13(l) 49-53. 

The DRESS syndrome is an acronym for Drug Rash with Eosinophilia and Systemic Symptoms. It is also known as the Drug-Induced Pseudolymphoma and Drug Hypersensitivity Syndrome. The symptoms of DRESS syndrome usually begin I to 8 weeks after exposure to the offending drug. Common causes include carbamazepine, phenobarbital, phenytoin, terbinafine, and valproic acid. 

Carbamazepine (CBZ) is a widely used anticonvulsant that can cause rashes in up to 10% of patients, and in occasional cases this may be the precursor to the development of a hypersensitivity syndrome characterized by systemic manifestations such as fever and eosinophilia (Feeder 1998 Vittorio and Muglia 1995). Rarely, CBZ can induce blistering skin reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis, two conditions associated with a high fatality rate (Rzany et al. 1999). There is now increasing laboratory evidence to show that... 

Chang HJ, Wang N, Quan YP, Xing XM. Fever, mild elevation in liver function tests, leucopenia of carbamazepine-induced anticonvulsant hypersensitivity syndrome. Neurol India 2011 59(1) 72-3. 

Skin The clinical and laboratory findings of anticonvulsant hypersensitivity syndrome have been retrospectively evaluated using the medical records of 31 patients over a 12-year period [42 ]. The syndrome was related to carbamazepine in 48% of all cases, phe-nytoin in 35%, and lamotrigine in 9.6%, and in co-treatment with lamotrigine and valproic acid in 6.5% of cases. Symptoms appeared at 2-86 (mean 36) days after the start of treatment. The rashes were... 

Suzuki Y, Fukuda M, Tohyama M, Ishikawa M, Yasukawa M, Ishii E. Carbamazepine-induced drug-induced hypersensitivity syndrome in a 14-year-old Japanese boy. Epilepsia 2008 49(12) 2118-21. 

Aouam K, Ben Romdhane F, Loussaief C, Salem R, Toumi A, Belhadjali H, Chaabane A, Boughattas NA, Chakroun M. Hypersensitivity syndrome induced by anticonvulsants possible cross-reactivity between carbamazepine and lamotrigine. J Clin Pharmacol 2009 49(12) 1488-91. 

Kang SY, Kim JY, Kim MY, Lee SY, Kim MH, Kim TW, et al. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms syndrome induced by cilostazol and carbamazepine. J Dermatol August 2012 39(8) 723-4. 

A skin rash occurs in 5-20% of patients started on carbamazepine, and is a common cause of early drug withdrawal. The rash is usually erythematous or maculopapular and may accompany systemic manifestations of hypersensitivity. Exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis are relatively rare (SED-13, 148) (55,56). 

Hypersensitivity to barbiturates can result in a life-threatening syndrome called the Drug, Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome with a mortality of 10%. In persons developing hypersensitivity to barbiturates, there is a potential of cross-sensitivity with other aromatic antiepileptics, such as phenytoin and carbamazepine. 

Rashes are the most frequent hypersensitivity response. An incidence of approximately 10% has been reported. These usually are mildly eczematous but may progress to Stevens-Johnson syndrome. Other rare side effects reported with carbamazepine include hepatitis, osteomalacia, cardiac conduction defects, and lupus-like reactions. 

The application of genomics promises to better explain and ultimately reduce some ADRs. Results so far have demonstrated the association in Han Chinese of carbamazepine-indnced Stevens-Johnson syndrome with the HLA-B 15 02 allele and the association of abacavir hypersensitivity in AHS with HLA-B 57 01. 

In the Han Chinese population, genetic polymorphisms at HLA-B 1502 are associated with an increased risk for carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS), while HLA-A 3101 polymorphisms are associated with an increased risk for drug hypersensitivity to CBZ [1 ]. Studies on Caucasian populations did not consistently reproduce the same associations [2,3 ] although a more recent multiethnic study population in Canada demonstrated similar associations to those seen in the Han Chinese population In addition, HLA-A 2402 allele is linked... 

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