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Cross Sensitivity of Skin Rashes with Antiepileptic Drugs

Published online by Cambridge University Press:  18 September 2015

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Abstract:

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Objective:

Skin rashes are a well known complication of antiepileptic drug (AED) treatment. It has also been recognized that some patients will develop rashes from multiple AEDs (cross sensitivity). There are very few studies that have attempted to determine the frequency of cross sensitivity among AEDs.

Methods:

Charts of all patients attending an epilepsy outpatient clinic were reviewed to determine AED exposure and the occurrence of a rash from AEDs.

Results:

633 patients had 1,875 exposures to 14 AEDs. Rashes occurred from carbamazepine (N = 27), phenytoin ( N = 21), phenobarbital (N = 5) and lamotrigine (N = 1). A rash from 2 or more AEDs occurred in 14 patients and involved predominantly carbamazepine and phenytoin. Among the patients exposed to both phenytoin and carbamazepine 10/17 (58%) of patients with a rash from phenytoin also had a rash from carbamazepine; conversely 10/25 (40%) patients with a carbamazepine rash also had a rash from phenytoin. 4/5 patients with a phenobarbital rash were sensitive to carbamazepine and/or phenytoin. Amongst the other most commonly used AEDs no rashes occurred from valproic acid or clobazam.

Conclusions:

The cross sensitivity rate for rashes involving carbamazepine and phenytoin is 40-58%. If a rash develops from either of these AEDs, valproate or clobazam are safe alternatives.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 3 , August 1997 , pp. 245 - 249
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

REFERENCES

1.Chadwick, D, Shaw, MBM, Foy, P, Rawlins, MD, Turnbull, DM. Serum anticonvulsant concentrations and the risk of drug induced skin eruptions. J Neurol Neurosurg Psychiatry 1984; 47: 642–644.CrossRefGoogle ScholarPubMed
2.Richens, A, Davidson, DL, Cartlidge, NE, Easter, DJ. A multicentre comparative trial of sodium valproate and carbamazepine in adult onset epilepsy. J Neurol Neurosurg Psychiatry 1994; 57: 682–687.CrossRefGoogle ScholarPubMed
3.Brodie, MJ, Richens, A, Yuen, AWC. Double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy. Lancet 1995; 345: 476–479.CrossRefGoogle ScholarPubMed
4.Sillanpaa, M. Carbamazepine: pharmacology and clinical uses. Acta Neurol Scand 1981; 64 (Suppl. 88): 1–102.Google Scholar
5.Kramlinger, KG, Phillips, KA, Post, RM. Rash complicating carbamazepine therapy. J Clin Psychopharmacol 1994; 14: 408–413.CrossRefGoogle Scholar
6.Mattson, RH, Cramer, J, Collins, JF. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. N Engl J Med 1992; 327: 765–771.CrossRefGoogle ScholarPubMed
7.Knutsen, AP, Anderson, J, Satayaviboon, S, Slavin, RG. Immunologic aspects of phenobarbital hypersensitivity. J Pediatr 1984; 105: 558–563.CrossRefGoogle ScholarPubMed
8.Dreifuss, FE, Langer, DH. Side effects of valproate. Am J Med 1988; 84 (Suppl. 4): 34–41.CrossRefGoogle ScholarPubMed
9.Roujeau, JC, Sterns, RS. Severe adverse cutaneous reactions to drugs. N Engl J Med 1994; 331: 1272–1278.CrossRefGoogle ScholarPubMed
10.Pelekanos, J, Camfield, P, Camfield, C, Gordon, K.Allergic rash due to antiepileptic drugs: clinical features and management. Epilepsia 1991; 32: 544–559.CrossRefGoogle ScholarPubMed
11.Dean, AG, Dean, JA, Burton, AH, Dicker, RC. Epi Info: a general purpose microcomputer program for public health information systems. Am J Pre v Med 1991; 7: 178–182.CrossRefGoogle ScholarPubMed
12.Shear, N, Spielberg, SP. Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk. J Clin Invest 1988; 82: 1826–1832.CrossRefGoogle ScholarPubMed
13.Kahn, HD, Faguet, GB, Agee, JF, Middleton, HM. Drug induced liver injury. In vitro demonstration of hypersensitivity to both phenytoin and phenobarbital. Arch Intern Med 1984; 144: 1677–1679.CrossRefGoogle ScholarPubMed
14.Goldstein, N, Leider, M, Baer, R. Drug eruptions from anticonvulsant drugs. Arch Dermatol 1963; 87: 612–617.CrossRefGoogle ScholarPubMed
15.Reents, SB, Luginbuhl, WE, Davis, SM. Phenytoin-carbamazepine cross-sensitivity. DICP 1989; 23: 235–236.Google ScholarPubMed
16.Pirmohamed, M, Graham, A, Roberts, P, et al. Carbamazepine-hyper-sensitivity: assessment of clinical and in vitro chemical cross reactivity with phenytoin and oxcarbazepine. Br J Pharmac 1991; 32: 741–749.CrossRefGoogle ScholarPubMed
17.Chang, DKM, Shear, NH. Cutaneous reactions to anticonvulsants. Semin Neurol 1992; 12: 329–337.CrossRefGoogle ScholarPubMed
18.Richens, A. Safety of lamotrigine. Epilepsia 1994; 35 (Suppl. 5): S37-S40.CrossRefGoogle ScholarPubMed
19.Smith, H, Newton, R. Adverse reactions to carbamazepine managed by desensitization (Letter). Lancet 1985; 1: 753.CrossRefGoogle Scholar
20.Eames, P. Adverse reactions to carbamazepine managed by desensitization (Letter) Lancet 1989; 1: 509–510.CrossRefGoogle Scholar
21.Tavernor, SJ, Wong, IC, Newton, R, Brown, SW. Rechallenge with lamotrigine after initial rash. Seizure 1995; 4: 67–71.CrossRefGoogle ScholarPubMed
22.Heller, AJ, Chesterman, P, Elwes, RDC, et al. Phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed adult epilepsy: a randomised comparative monotherapy trial. J Neurol Neurosurg Psychiatry 1995; 58: 44–50.CrossRefGoogle ScholarPubMed
23.Mclean, MJ. Gabapentin. Epilepsia 1995; 36 (Suppl. 2): S73-S86.CrossRefGoogle ScholarPubMed
24.Ben-Menachem, E.Vigabatrin. Epilepsia 1995; 36 (Suppl. 2): S95-S104.CrossRefGoogle ScholarPubMed