ANTICONVULSANT HYPERSENSITIVITY SYNDROME - 10/09/11

Doi : 10.1016/S0749-0704(05)70366-3

Anthony R. Morkunas, PharmD, BCPS ^a, Mary Beth Miller, DO ^b
^a Departments of Medical Education, Good Samaritan Regional Medical Center, Phoenix, Arizona (ARM)
^b the Emergency Medicine Residency Program, Michigan State University, Lansing, Michigan (MBM)

Résumé

Anticonvulsant hypersensitivity syndrome (AHS) is an uncommon, but potentially fatal, multisystem disorder that occurs after exposure to phenytoin, carbamazepine, or phenobarbital. Its incidence is estimated to range from 1 per 1000 to 1 per 10,000 exposures.^{3Bertz R.J., Howrie D.L. Diazepam by continuous intravenous infusion for status epilepticus in anticonvulsant hypersensitivity syndrome Ann Pharmacother 1993 ; 27 : 298

Cliquez ici pour aller à la section Références, 8Chang D.K.M., Shear N.H. Cutaneous reactions to anticonvulsants Semin Neurol 1992 ; 12 : 329

Cliquez ici pour aller à la section Références, 11Gaedigk A., Spielberg S.P., Grant D.M. Characterization of the microsomal epoxide hydrolase gene in patients with anticonvulsant adverse drug reactions Pharmacogenetics 1994 ; 4 : 142 [cross-ref]

Cliquez ici pour aller à la section Références, 13Gennis M.A., Vermuri R., Burns E.A., et al. Familial occurrence of hypersensitivity to phenytoin Am J Med 1991 ; 91 : 631 [cross-ref]

Cliquez ici pour aller à la section Références, 29Leeder J.S., Riley R.J., Cook V.A., et al. Human anti-cytochrome P450 antibodies in aromatic anticonvulsant-induced hypersensitivity reactions J Pharmacol Exp Ther 1992 ; 263 : 360

Cliquez ici pour aller à la section Références, 57Vittorio C.C., Muglia J.J. Anticonvulsant hypersensitivity syndrome Arch Intern Med 1995 ; 155 : 2285

Cliquez ici pour aller à la section Références} With diverse clinical features and variable presentations, there often is a delay in making the correct diagnosis. Furthermore, cross-reactivity between these three anticonvulsants may exceed 50%, explaining why patients may worsen when one anticonvulsant is stopped and one of the others begun. Physicians must be familiar with the spectrum of AHS to recognize the syndrome early, and must understand the implications for reactions to other anticonvulsants when a hypersensitivity reaction is recognized. This article describes the time course and general features of the syndrome and briefly reviews the history of hypersensitivity reactions for each drug. The pathophysiology that is thought to explain both the occurrence of AHS and cross-reactivity between the three drugs along with new diagnostic tests and suggestions for therapy are also reviewed. The potential for felbamate as a cause of AHS is also discussed.