Desensitization to allopurinol in patients with gout and cutaneous reactions.
OBJECTIVE
To determine the efficacy and safety of slow oral desensitization in the management of allopurinol-related pruritic cutaneous eruptions.


METHODS
Nine patients with renal insufficiency and chronic tophaceous gouty arthritis, who had to interrupt their allopurinol therapy because of an allergic-type pruritic maculopapular eruption, were enrolled in an allopurinol oral desensitization protocol using a schedule of gradually increasing doses.


RESULTS
Cautious reinstitution of allopurinol was successfully accomplished in all nine patients, but four individuals required dose adjustment because of development of a mild, recurrent, macular rash early during the protocol at allopurinol doses of less than or equal to 5 mg/d. Transient, postdesensitization cutaneous reactions occurred in two patients, one of whom also had an early rash.


CONCLUSIONS
Oral desensitization to the minor rashes induced by allopurinol is a feasible and acceptably safe approach to therapy, particularly for those with renal insufficiency in whom no substitute urate-lowering drug is available.
Fam
A G
AG
Division of Rheumatology, University of Toronto, Ontario, Canada.
Lewtas
J
J
Stein
J
J
Paton
T W
TW
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D002908:Chronic Disease; D003888:Desensitization, Immunologic; D003875:Drug Eruptions / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006073:Gout / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000139:chemically induced
D000493:Allopurinol