Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele

Kumi Sakurada,1,* Takeshi Kozaru,2,* Kazuo Yamada,1 Masashi Nibuya,1 Kiyoshi Nagata,3 Eiji Suzuki1 1Department of Psychiatry, 2Department of Dermatology, 3Department of Environmental and Health Science, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan *These authors contributed...

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Autores principales: Sakurada K, Kozaru T, Yamada K, Nibuya M, Nagata K, Suzuki E
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Publicado: Dove Medical Press 2018
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spelling oai:doaj.org-article:784408bdd3224b73880cf44760e850492021-12-02T01:21:36ZAllergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele1178-2021https://doaj.org/article/784408bdd3224b73880cf44760e850492018-05-01T00:00:00Zhttps://www.dovepress.com/allergy-to-chlorpromazine-and-valproic-acid-following-carbamazepine-hy-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Kumi Sakurada,1,* Takeshi Kozaru,2,* Kazuo Yamada,1 Masashi Nibuya,1 Kiyoshi Nagata,3 Eiji Suzuki1 1Department of Psychiatry, 2Department of Dermatology, 3Department of Environmental and Health Science, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan *These authors contributed equally to this work Abstract: A 73-year-old man, exhibiting psychomotor excitement after traumatic brain injury, developed allergic cutaneous eruptions and hepatic inflammation that did not resolve after the cessation of carbamazepine (CBZ). Fusing maculopapular erythema was observed in the face, neck, presternal region, and bilaterally in the forearms and feet. A drug-induced lymphocyte stimulation test revealed hypersensitivity to chlorpromazine (CPZ) and valproic acid (VPA), as well as to CBZ. The allergic reaction with eosinophilia to CPZ and VPA was suspected to have emerged following CBZ hypersensitivity, since previous treatment with CPZ and VPA prior to the introduction of CBZ had not been associated with adverse reactions earlier in the course of treatment. Recent studies have indicated linkages between severe CBZ hypersensitivity – but not mild CBZ hypersensitivity – and specific leukocyte antigens, HLA-B*1502 and HLA-A*3101, in Asian and European populations. The present case exhibited the HLA-B*4601 allele, which is associated with a high relative risk for the development of CBZ-induced maculopapular eruptions in Japanese and Han Chinese populations. Although cross-hypersensitivity among aromatic compounds, including CBZ and CPZ, is well-established, data regarding CBZ allergy-associated hypersensitivity to VPA are limited. In the present case, a cutaneous allergy to mianserin (a tetracyclic antidepressant) was also observed later in the course of treatment, suggesting additional cross-reactivity exists among aromatic psychotropic drugs. Thus, the association between the HLA-B*4601 allele and allergic reactions to VPA, aromatic psychotropic drugs, and CBZ should be further examined in future studies. Keywords: human leukocyte antigen, pharmacogenomics, maculopapular erythema, carbamazepine, chlorpromazine, valproic acidSakurada KKozaru TYamada KNibuya MNagata KSuzuki EDove Medical Pressarticlehuman leukocyte antigenpharmacogenomicsmaculopapular erythemacarbamazepinechlorpromazinevalproic acidNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 14, Pp 1139-1142 (2018)
institution DOAJ
collection DOAJ
language EN
topic human leukocyte antigen
pharmacogenomics
maculopapular erythema
carbamazepine
chlorpromazine
valproic acid
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
spellingShingle human leukocyte antigen
pharmacogenomics
maculopapular erythema
carbamazepine
chlorpromazine
valproic acid
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Sakurada K
Kozaru T
Yamada K
Nibuya M
Nagata K
Suzuki E
Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele
description Kumi Sakurada,1,* Takeshi Kozaru,2,* Kazuo Yamada,1 Masashi Nibuya,1 Kiyoshi Nagata,3 Eiji Suzuki1 1Department of Psychiatry, 2Department of Dermatology, 3Department of Environmental and Health Science, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan *These authors contributed equally to this work Abstract: A 73-year-old man, exhibiting psychomotor excitement after traumatic brain injury, developed allergic cutaneous eruptions and hepatic inflammation that did not resolve after the cessation of carbamazepine (CBZ). Fusing maculopapular erythema was observed in the face, neck, presternal region, and bilaterally in the forearms and feet. A drug-induced lymphocyte stimulation test revealed hypersensitivity to chlorpromazine (CPZ) and valproic acid (VPA), as well as to CBZ. The allergic reaction with eosinophilia to CPZ and VPA was suspected to have emerged following CBZ hypersensitivity, since previous treatment with CPZ and VPA prior to the introduction of CBZ had not been associated with adverse reactions earlier in the course of treatment. Recent studies have indicated linkages between severe CBZ hypersensitivity – but not mild CBZ hypersensitivity – and specific leukocyte antigens, HLA-B*1502 and HLA-A*3101, in Asian and European populations. The present case exhibited the HLA-B*4601 allele, which is associated with a high relative risk for the development of CBZ-induced maculopapular eruptions in Japanese and Han Chinese populations. Although cross-hypersensitivity among aromatic compounds, including CBZ and CPZ, is well-established, data regarding CBZ allergy-associated hypersensitivity to VPA are limited. In the present case, a cutaneous allergy to mianserin (a tetracyclic antidepressant) was also observed later in the course of treatment, suggesting additional cross-reactivity exists among aromatic psychotropic drugs. Thus, the association between the HLA-B*4601 allele and allergic reactions to VPA, aromatic psychotropic drugs, and CBZ should be further examined in future studies. Keywords: human leukocyte antigen, pharmacogenomics, maculopapular erythema, carbamazepine, chlorpromazine, valproic acid
format article
author Sakurada K
Kozaru T
Yamada K
Nibuya M
Nagata K
Suzuki E
author_facet Sakurada K
Kozaru T
Yamada K
Nibuya M
Nagata K
Suzuki E
author_sort Sakurada K
title Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele
title_short Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele
title_full Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele
title_fullStr Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele
title_full_unstemmed Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele
title_sort allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an hla-b*4601 allele
publisher Dove Medical Press
publishDate 2018
url https://doaj.org/article/784408bdd3224b73880cf44760e85049
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