Anticonvulsant hypersensitivity syndrome: Is there a role for immunomodulation?
dc.contributor.author | Cumbo-Nacheli, Gustavo | en_US |
dc.contributor.author | Weinberger, Jarrett | en_US |
dc.contributor.author | Alkhalil, Michel | en_US |
dc.contributor.author | Thati, Neelima | en_US |
dc.contributor.author | Baptist, Alan P. | en_US |
dc.date.accessioned | 2010-04-01T15:07:31Z | |
dc.date.available | 2010-04-01T15:07:31Z | |
dc.date.issued | 2008-12 | en_US |
dc.identifier.citation | Cumbo-Nacheli, Gustavo; Weinberger, Jarrett; Alkhalil, Michel; Thati, Neelima; Baptist, Alan P. (2008). "Anticonvulsant hypersensitivity syndrome: Is there a role for immunomodulation?." Epilepsia 49(12): 2108-2112. <http://hdl.handle.net/2027.42/65590> | en_US |
dc.identifier.issn | 0013-9580 | en_US |
dc.identifier.issn | 1528-1167 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/65590 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=18637830&dopt=citation | en_US |
dc.description.abstract | The anticonvulsant hypersensitivity syndrome (AHS) is an idiosyncratic immunologic reaction to certain anticonvulsant medications, in which internal organ involvement may lead to fatal multisystemic failure. This syndrome has been associated with the use of aromatic ring-containing agents such as phenytoin, carbamazepine, or phenobarbitone. Clinically, this condition presents with the classic triad of fever, rash, and lymphadenopathy. We review the existing literature on AHS pathogenesis and illustrate a case complicated by liver dysfunction where the use of N-acetylcysteine (N-AC) and intravenous immunoglobulin (IVIG) may have altered the course of the disease. The rationale of suggesting N-AC and IVIG for the treatment of this syndrome relies on the theoretical synergistic effects of the two agents. Although treatment for this syndrome remains controversial and relies heavily on anecdotal evidence, the progression of hepatic injury may be prevented by the addition of N-AC. The scavenging properties of N-AC may palliate and possibly prevent free radical-mediated liver damage. In addition, IVIG may effectively modulate the overreactive immune system in AHS. We discuss the possible role of using immunomodulating agents for the treatment of this syndrome and suggest that alternative regimens should be given special consideration especially in those critical clinical situations where supportive measures appear to be unsuccessful. | en_US |
dc.format.extent | 204643 bytes | |
dc.format.extent | 3110 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.publisher | Blackwell Publishing Ltd | en_US |
dc.rights | Copyright © 2008 by the International League Against Epilepsy | en_US |
dc.subject.other | Anticonvulsant Hypersensitivity Syndrome | en_US |
dc.subject.other | N-acetylcysteine | en_US |
dc.subject.other | Intravenous Immunoglobulin | en_US |
dc.subject.other | Immunomodulation | en_US |
dc.subject.other | Drug Reaction | en_US |
dc.subject.other | Liver Injury | en_US |
dc.title | Anticonvulsant hypersensitivity syndrome: Is there a role for immunomodulation? | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | * Department of Internal Medicine, Wayne State University, Detroit, Michigan, U.S.A. | en_US |
dc.contributor.affiliationum | † Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan, U.S.A. | en_US |
dc.identifier.pmid | 18637830 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/65590/1/j.1528-1167.2008.01720.x.pdf | |
dc.identifier.doi | 10.1111/j.1528-1167.2008.01720.x | en_US |
dc.identifier.source | Epilepsia | en_US |
dc.identifier.citedreference | Agusti AG, Togores B, Ibanez J, Raurich JM, Maimo A, Bergada J, Marse P, Jorda R. ( 1997 ) Effects of N-acetylcysteine on tissue oxygenation in patients with multiple organ failure and evidence of tissue hypoxia. Eur Respir J 10 : 1962 – 1966. | en_US |
dc.identifier.citedreference | Ben-Ari Z, Vaknin H, Tur-Kaspa R. ( 2000 ) N-acetylcysteine in acute hepatic failure (non-paracetamol-induced). Hepatogastroenterology 47 : 786 – 789. | en_US |
dc.identifier.citedreference | Bergamini S, Rota C, Canali R, Staffieri M, Daneri F, Bini A, Giovannini F, Tomasi A, Iannone A. ( 2001 ) N-acetylcysteine inhibits in vivo nitric oxide production by inducible nitric oxide synthase. Nitric Oxide 5 : 349 – 360. | en_US |
dc.identifier.citedreference | Bohan KH, Mansuri TF, Wilson NM. ( 2007 ) Anticonvulsant hypersensitivity syndrome: implications for pharmaceutical care. Pharmacotherapy 27 : 1425 – 1439. | en_US |
dc.identifier.citedreference | Brown CE, Smith GD, Coniglione T. ( 1997 ) Anticonvulsant hypersensitivity: an unfortunate case of triple exposure to phenytoin. J Fam Pract 45 : 434 – 437. | en_US |
dc.identifier.citedreference | De Swert LF, Ceuppens JL, Teuwen D, Wijndaele L, Casaer P, Casteels-Van Daele M. ( 1984 ) Acute interstitial pneumonitis and carbamazepine therapy. Acta Paediatr Scand 73 : 285 – 288. | en_US |
dc.identifier.citedreference | Devlin J, Ellis AE, McPeake J, Heaton N, Wendon JA, Williams R. ( 1997 ) N-acetylcysteine improves indocyanine green extraction and oxygen transport during hepatic dysfunction. Crit Care Med 25 : 236 – 242. | en_US |
dc.identifier.citedreference | De Vriese AS, Philippe J, Van Renterghem DM, De Cuyper CA, Hindryckx PH, Matthys EG, Louagie A. ( 1995 ) Carbamazepine hypersensitivity syndrome: report of 4 cases and review of the literature. Medicine (Baltimore) 74 : 144 – 151. | en_US |
dc.identifier.citedreference | Dwivedi R, Gogtay N, Kharkar V, Amladi S, Kshirsagar N. ( 2004 ) In-vitro lymphocyte toxicity to a phenytoin metabolite in phenytoin induced cutaneous adverse drug eruptions. Indian J Dermatol Venereol Leprol 70 : 217 – 220. | en_US |
dc.identifier.citedreference | Fervenza FC, Kanakiriya S, Kunau RT, Gibney R, Lager DJ. ( 2000 ) Acute granulomatous interstitial nephritis and colitis in anticonvulsant hypersensitivity syndrome associated with lamotrigine treatment. Am J Kidney Dis 36 : 1034 – 1040. | en_US |
dc.identifier.citedreference | Gressier B, Cabanis A, Lebegue S, Brunet C, Dine T, Luyckx M, Cazin M, Cazin JC. ( 1994 ) Decrease of hypochlorous acid and hydroxyl radical generated by stimulated human neutrophils: comparison in vitro of some thiol-containing drugs. Methods Find Exp Clin Pharmacol 16 : 9 – 13. | en_US |
dc.identifier.citedreference | Harrison PM, Wendon JA, Gimson AE, Alexander GJ, Williams R. ( 1991 ) Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med 324 : 1852 – 1857. | en_US |
dc.identifier.citedreference | James LP, Mayeux PR, Hinson JA. ( 2003 ) Acetaminophen-induced hepatotoxicity. Drug Metab Dispos 31 : 1499 – 1506. | en_US |
dc.identifier.citedreference | Kazatchkine MD, Kaveri SV. ( 2001 ) Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med 345 : 747 – 755. | en_US |
dc.identifier.citedreference | Kennebeck GA. ( 2000 ) Anticonvulsant hypersensitivity syndrome. J Am Board Fam Pract 13 : 364 – 370. | en_US |
dc.identifier.citedreference | Knowles SR, Shear NH. ( 2007 ) Recognition and management of severe cutaneous drug reactions. Dermatol Clin 25 : 245 – 253. | en_US |
dc.identifier.citedreference | Knowles SR, Shapiro LE, Shear NH. ( 1999 ) Anticonvulsant hypersensitivity syndrome: incidence, prevention and management. Drug Saf 21 : 489 – 501. | en_US |
dc.identifier.citedreference | Korem M, Hiller N, Ackerman Z, Chajek-Shaul T, Abramowitz Y. ( 2006 ) Spleen rupture secondary to anticonvulsant hypersensitivity syndrome. Eur J Intern Med 17 : 517 – 519. | en_US |
dc.identifier.citedreference | Krauss G. ( 2006 ) Current understanding of delayed anticonvulsant hypersensitivity reactions. Epilepsy Curr 6 : 33 – 37. | en_US |
dc.identifier.citedreference | Li AM, Nelson EA, Hon EK, Cheng FW, Chan DF, Sin NC, Ma KC, Cheung KL, Fok TF. ( 2005 ) Hepatic failure in a child with anti-epileptic hypersensitivity syndrome. J Paediatr Child Health 41 : 218 – 220. | en_US |
dc.identifier.citedreference | Mason ME. ( 2007 ) Anticonvulsant hypersensitivity syndrome: recognizing the signs and symptoms. Resid Staff Physician 53 :29-36. | en_US |
dc.identifier.citedreference | Mittmann N, Chan B, Knowles S, Cosentino L, Shear N. ( 2006 ) Intravenous immunoglobulin use in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. Am J Clin Dermatol 7 : 359 – 368. | en_US |
dc.identifier.citedreference | Morkunas AR, Miller MB. ( 1997 ) Anticonvulsant hypersensitivity syndrome. Crit Care Clin 13 : 727 – 739. | en_US |
dc.identifier.citedreference | Mostella J, Pieroni R, Jones R, Finch CK. ( 2004 ) Anticonvulsant hypersensitivity syndrome: treatment with corticosteroids and intravenous immunoglobulin. South Med J 97 : 319 – 321. | en_US |
dc.identifier.citedreference | Pastor-MilÁn E, Rubert-GÓmez MA, VÁzquez-GutiÉrrez F, GonzÁlez V. ( 2003 ) Oxcarbazepine induced interstitial nephritis in a patient with drug hypersensitivity syndrome. Rev Neurol 37 : 948 – 950. | en_US |
dc.identifier.citedreference | Redondo P, de Felipe I, de la Pena A, Aramendia JM, Vanaclocha V. ( 1997 ) Drug-induced hypersensitivity syndrome and toxic epidermal necrolysis. Treatment with N-acetylcysteine. Br J Dermatol 136 : 645 – 646. | en_US |
dc.identifier.citedreference | Rota C, Bergamini S, Daneri F, Tomasi A, Virgili F, Iannone A. ( 2002 ) N-Acetylcysteine negatively modulates nitric oxide production in endotoxin-treated rats through inhibition of NF-ΚB activation. Antioxid Redox Signal 4 : 221 – 226. | en_US |
dc.identifier.citedreference | Scheuerman O, Nofech-Moses Y, Rachmel A, Ashkenazi S. ( 2001 ) Successful treatment of antiepileptic drug hypersensitivity syndrome with intravenous immune globulin. Pediatrics 107 : E14. | en_US |
dc.identifier.citedreference | Shear NH, Spielberg SP. ( 1988 ) Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk. J Clin Invest 82 : 1826 – 1832. | en_US |
dc.identifier.citedreference | Sheiner P, De Majo W, Levy GA. ( 1992 ) Acetylcysteine and fulminant hepatic failure. Hepatology 15 : 552 – 554. | en_US |
dc.identifier.citedreference | Simonart T, Tugendhaft P, Vereecken P, de Dobbeleer G, Heenen M. ( 1998 ) Hazards of therapy with high doses of N-acetylcysteine for anticonvulsant-induced hypersensitivity syndrome. Br J Dermatol 138 : 553. | en_US |
dc.identifier.citedreference | Tas S, Simonart T, Heenen M. ( 2001 ) Angio-oedema caused by high doses of N-acetylcysteine in patients with anticonvulsant hypersensitivity syndrome. Br J Dermatol 145 : 856 – 857. | en_US |
dc.identifier.citedreference | Ting TY. ( 2007 ) Anticonvulsant hypersensitivity syndrome: identification and management. Curr Treat Options Neurol 9 : 243 – 248. | en_US |
dc.identifier.citedreference | Viard I, Wehrli P, Bullani R, Schneider P, Holler N, Salomon D, Hunziker T, Saurat JH, Tschopp J, French LE. ( 1998 ) Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Science 282 : 490 – 493. | en_US |
dc.identifier.citedreference | Vittorio CC, Muglia JJ. ( 1995 ) Anticonvulsant hypersensitivity syndrome. Arch Intern Med 155 : 2285 – 2290. | en_US |
dc.identifier.citedreference | Walsh TS, Lee A. ( 1999 ) N-acetylcysteine administration in the critically ill. Intensive Care Med 25 : 432 – 434. | en_US |
dc.identifier.citedreference | Wu Y, Sanderson JP, Farrell J, Drummond NS, Hanson A, Bowkett E, Berry N, Stachulski AV, Clarke SE, Pichler WJ, Pirmohamed M, Park BK, Naisbitt DJ. ( 2006 ) Activation of T cells by carbamazepine and carbamazepine metabolites. J Allergy Clin Immunol 118 : 233 – 241. | en_US |
dc.identifier.citedreference | Zaidi AN. ( 2005 ) Anticonvulsant hypersensitivity syndrome leading to reversible myocarditis. Can J Clin Pharmacol 12 : e33–e40. | en_US |
dc.identifier.citedreference | Ziment I. ( 1988 ) Acetylcysteine: a drug that is much more than a mucokinetic [review]. Biomed Pharmacother 42 : 513 – 519. | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.