HLA-B*1502 and carbamazepine-induced severe cutaneous adverse drug reactions in Vietnamese.
BACKGROUND
In Vietnam, we observed a high incidence of carbamazepine (CBZ)-induced severe cutaneous adverse drug reactions (SCARs)-Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and drug-induced hypersensitivity rash with eosinophilia and systemic symptoms (DRESS). In other Asian countries, HLA-B(*)1502 is an established risk factor for SCARs.


OBJECTIVE
The aim of our study was to determine the frequency of HLA-B(*)1502 in SCARs patients at a large University Medical Center in Hanoi, Vietnam.


METHODS
Thirty-eight cases of SCARs caused by CBZ and 25 patients with epilepsy tolerating CBZ were enrolled in a case-controlled study. Clinical manifestations and laboratory findings were recorded for each subject. Genomic DNA was isolated using the QIAamp DNA purification system. The combination of polymerase chain reaction and sequence specific oligonucleotide probes with the Luminex 100×MAP flow cytometry dual laser system was then used to quantitate fluorescently labelled oligonucleotides attached to colour-coded microbeads.


RESULTS
Cases comprised 20 SJS (52.6%), 7 TEN (18.4%), 8 overlap syndrome (21.1%), and 3 DRESS patients (7.9%). A strong association between HLA B(*)1502 and bullous skin reactions such as SJS/TEN and overlap was confirmed with an odds ratio (OR) of 33.78 (95% confidence interval [CI], 7.55-151.03), p < 0.0001, Sensitivity 91.4%, Specificity 76.0%, positive predictive value 84.2%, and negative predictive value 86.4%. We did not, however, observe any correlation between the presence of this allele and CBZ-induced nonbullous skin reactions (DRESS) (OR, 6.33; 95% CI, 0.48-82.74; p = 0.1592).


CONCLUSIONS
Our results indicate the presence of HLA-B(*)1502 in Vietnamese is a pharmacogenetic risk factor for developing CBZ-induced SJS/TEN.
Department of Allergy and Clinical Immunology, Hanoi Medical University, Hanoi 10000, Vietnam. ; Center of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi 844, Vietnam. ; Department of Allergy and Clinical Immunology, Royal North Shore Hospital and Sydney Medical School-Northern, The University of Sydney, Sydney, NSW 2065, Australia.
Dinh Van
DV
Nguyen
Center of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi 844, Vietnam.
Hieu Chi
HC
Chu
Department of Allergy and Clinical Immunology, Hanoi Medical University, Hanoi 10000, Vietnam. ; Center of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi 844, Vietnam.
Doan Van
DV
Nguyen
Outpatients Department, Bach Mai Hospital, Hanoi 844, Vietnam.
Minh Hong
MH
Phan
Section of Allergy, Asthma and Immunology, Penn State University, Hershey, PA 17033, USA.
Timothy
T
Craig
Sonic Clinical Institute, Macquarie Park, Sydney, NSW 2113, Australia.
Karl
K
Baumgart
Department of Allergy and Clinical Immunology, Royal North Shore Hospital and Sydney Medical School-Northern, The University of Sydney, Sydney, NSW 2065, Australia.
Sheryl
S
van Nunen
Carbamazepine; Drug-related side effects and adverse reactions; HLA-B antigens; Pharmacogenomics