AUTHOR=Manson Lisanne E. N. , Chan Patricia C. Y. , Böhringer Stefan , Guchelaar Henk-Jan 

TITLE=Genotyping for HLA risk alleles versus patch tests to diagnose anti-seizure medication induced cutaneous adverse drug reactions

JOURNAL=Frontiers in Pharmacology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.1061419

DOI=10.3389/fphar.2022.1061419

ISSN=1663-9812

ABSTRACT=<p><bold>Aim:</bold> To provide a comparison of genotyping for HLA risk alleles versus patch testing to determine which of these two tests is a better diagnostic tool for cutaneous hypersensitivity reactions caused by anti-seizure medication.</p><p><bold>Methods:</bold> A literature study was performed in PubMed to assess the sensitivity and specificity of HLA genotyping and patch tests for identifying anti-seizure medication induced cutaneous hypersensitivity reactions.</p><p><bold>Results:</bold> This study shows that HLA-B*15:02 genotyping shows high sensitivity for carbamazepine-induced SJS/TEN, especially in Han Chinese and Southeast Asian patients (66.7–100.0%) whereas the sensitivity of patch tests (0.0–62,5%), HLA-A*31:01 (0–50%) and HLA-B*15:11 (18.2–42.9%) are lower. On the contrary, for carbamazepine and phenytoin induced DRESS, patch tests (respectively 70.0–88.9% and 14.3–70.0%) show higher sensitivity than HLA tests (0–66.7% and 0–12.7%). Also for lamotrigine-induced DRESS patch tests perform better than HLA-B*15:02 (33.3–40.0 versus 0%). For anti-seizure medication induced MPE and for oxcarbazepine-induced SCARs more studies are needed.</p><p><bold>Conclusion:</bold> Use of HLA-B genotyping may aid clinicians in the diagnosis of carbamazepine, phenytoin, lamotrigine and oxcarbazepine induced SJS/TEN, particularly in Han Chinese and Southeast Asian patients. On the other hand, patch tests seem to perform better in the diagnosis of carbamazepine and phenytoin induced DRESS.</p>