HLA-B5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?

• Published in: Annals of the Academy of Medicine, Singapore Vol. 53; no. 3; pp. 211 - 212
• Main Authors: Ong, Felicia Li Ling, Pang, Shiu Ming
• Format: Journal Article
• Language: English
• Published: Singapore Academy of Medicine Singapore 27-03-2024
• Subjects: Allopurinol - therapeutic use; Gout - drug therapy; Gout Suppressants - therapeutic use; HLA-B Antigens - genetics; Humans; Singapore; Singapore; internal medicine; dermatology; pharmacogenomics; drug reactions; public health
• ISSN: 0304-4602; 2972-4066; 2972-4066; 0304-4602
• DOI: 10.47102/annals-acadmedsg.2023357

Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles have an increased risk of SJS/TEN with the use of allopurinol and carbamazepine, respectively.2 Consequently, much debate has arisen over the utility of pharmacogenomics in preventing SJS/ TEN. We will discuss the evidence surrounding genetic testing in the prevention of allopurinol- induced SJS/TEN, with the aim of highlighting the potential value of pre-testing.