title: Clinical features of and genetic predisposition to drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in a single Korean tertiary institution patients-investigating the relation between the HLA -B*4403 allele and lamotrigine.
abstract: OBJECTIVE
  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but fatal adverse mucocutaneous reactions to certain drugs. Recent studies suggest that ethnicity and genetic predisposition may play a crucial role in the manifestation of the reaction. In this study, we described the role of human leukocyte antigen (HLA)-B alleles in the development of clinical characteristics and treatment outcomes of SJS/TEN in a single Korean tertiary hospital.
  
  
  METHODS
  We retrospectively reviewed the medical records (from March 1, 2010 to February 28, 2014) of 30 patients diagnosed with SJS and/or TEN.
  
  
  RESULTS
  The main causative drugs were anticonvulsants (26.7 %) and allopurinol (26.7 %), followed by antibiotics (16.7 %), acetazolamide (10.0 %), acetaminophen (10.0 %), and herbal medication (6.7 %). The mean latencies of these drugs were variable. Liver damage was the most common symptom (observed in 63.3 % of the patients). Of the five patients with lamotrigine-induced SJS/TEN, three expressed the HLA-B*4403 allele (60.0 %). Of the seven patients with allopurinol-induced SJS/TEN, five expressed the HLA-B*5801 allele (71.4 %).
  
  
  CONCLUSIONS
  The major SJS/TEN-inducing drugs were found to be allopurinol and anticonvulsants (such as lamotrigine). We speculated that Korean individuals expressing the HLA-B*4403 allele may be highly susceptible to lamotrigine-induced SJS/TEN.
authors.affiliation: Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hye Jung
authors.initials: HJ
authors.lastname: Park
authors.forename: Sung Ryeol
authors.initials: SR
authors.lastname: Kim
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Leem
authors.forename: Il Joo
authors.initials: IJ
authors.lastname: Moon
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Koh
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Park
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Park
authors.forename: Jae-Hyun
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000086:Acetazolamide / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D000493:Allopurinol / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects*; D044466:Asian People / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D015235:HLA-B Antigens / Q000235:genetics*; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D010946:Plants, Medicinal / Q000009:adverse effects; D056910:Republic of Korea; D013262:Stevens-Johnson Syndrome / Q000209:etiology / Q000235:genetics*; D062606:Tertiary Care Centers; D014227:Triazines / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D015235:HLA-B Antigens; D014227:Triazines; D000082:Acetaminophen; D000493:Allopurinol; D000086:Acetazolamide; D000077213:Lamotrigine