title: Pharmacogenetic screening of carbamazepine-induced severe cutaneous allergic reactions.
abstract: Recent studies associated the HLA-B 1502 allele with carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in patients from China, Thailand and Malaysia. No association has been found in patients from Europe or Japan. Linkage summary reports from East and South-east Asia predict a highly significant odds ratio (OR) of 84.75 (95% confidence interval [CI]=42.53-168.91; p=8.96×10[-15]) with sensitivity and negative predictive values of 92% and 98%, respectively. The higher prevalence of HLA-B 1502 allele among certain Asian populations (10-15%) compared to Caucasians (1-2%) may explain a 10-fold to 25-fold higher incidence of CBZ-SJS/TEN in patients from Asia. Screening for HLA-B 1502 before using CBZ can prevent SJS/TEN in certain populations, but screening may be less beneficial in populations with low HLA-B 1502 allele frequency and in patients exposed to CBZ for more than 2 months. A retrospective study demonstrated that the costs of HLA-B 1502 screening were less than those of SJS treatment. This article reviews possible benefits and concerns of HLA-B 1502 screening in clinical practice.
authors.affiliation: Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. drchaichon@yahoo.com
authors.forename: Chaichon
authors.initials: C
authors.lastname: Locharernkul
authors.forename: Vorasuk
authors.initials: V
authors.lastname: Shotelersuk
authors.forename: Nattiya
authors.initials: N
authors.lastname: Hirankarn
mesh_terms: D044466:Asian People / Q000235:genetics; D002220:Carbamazepine / Q000009:adverse effects*; D003877:Dermatitis, Contact / Q000235:genetics; D005820:Genetic Testing / Q000379:methods*; D059910:HLA-B15 Antigen / Q000235:genetics*; D006801:Humans; D015994:Incidence; D010597:Pharmacogenetics / Q000379:methods*; D015995:Prevalence; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000235:genetics* / Q000276:immunology*
chemical_list: C483536:HLA-B*15:02 antigen; D059910:HLA-B15 Antigen; D002220:Carbamazepine