Stevens-Johnson syndrome risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]
Overview
Common risk factors in the development of SJS include immunodeficiency, HIV infection, active malignancy (particularly Hematological cancers), genetic Predisposition ( HLA-B 1502 and HLA-B 5801 variants in particular) on exposure to antiepileptic medications or Allopurinol. Other risk factors may include past or family history of SJS/TEN, radiation therapy and rapid use of medications.
Risk Factors
Common risk factors in the development of Stevens-Johnson Syndrome include the following:
HIV Infection
- Risk of Developing SJS is 100 times greater in HIV Infected people as compared to the general population[1]
Immunodeffeciency
- Immunodeffeciency also increases the risk of developing SJS/TEN. Conditions may include Autoimmune diseases like SLE, Organ Transplant and HIV/AIDS[2]
Malignancy
- Certain Malignancies increase the risk of SJS particularly Lymphomas and other Hematological cancers[3]
Genetic Factors
- Some people have genetic predisposition which increases their risk of developing SJS in response to certain trigger medications. The most common genetic variation contributing to the predisposition is seen in the HLA-B gene. Examples include
- People with HLA-B 1502 gene have 10 percent risk of developing SJS on exposure to anti-epileptic drugs like Phenytoin, Carbamazepine, Phenobarbital, Lamotrigine[4]
- People with HLA-B 5801 have high risk of developing SJS on exposure to Allupurinol[5]
- Certain studies have identified HLA-B 3101 as a genetic risk factor for Carbamazepine induced skin reactions including SJS[6]
- HLA-B 1511, HLA-B 2402 are also considered to increase SJS risk in certain populations
- Genetic polymorphism in CYP2C gene variants may lead to an increased risk of SJS/TEN on exposure to certain anti-seizure medications in some populations[7]
Others
Other factors that may increase the risk of SJS inclde;
- Past history of SJS
- Family history of SJS
- High dose of medications
- Rapid Intake of medications
- Physical stimuli like radiation therapy[8]
References
- ↑ Mittmann N, Knowles SR, Koo M, Shear NH, Rachlis A, Rourke SB (2012). "Incidence of toxic epidermal necrolysis and Stevens-Johnson Syndrome in an HIV cohort: an observational, retrospective case series study". Am J Clin Dermatol. 13 (1): 49–54. doi:10.2165/11593240-000000000-00000. PMID 22145749.
- ↑ Horne NS, Narayan AR, Young RM, Frieri M (2006). "Toxic epidermal necrolysis in systemic lupus erythematosus". Autoimmun Rev. 5 (2): 160–4. doi:10.1016/j.autrev.2005.10.003. PMID 16431352.
- ↑ Hsu DY, Brieva J, Silverberg NB, Silverberg JI (2016). "Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults". J Invest Dermatol. 136 (7): 1387–1397. doi:10.1016/j.jid.2016.03.023. PMID 27039263.
- ↑ Li X, Yu K, Mei S, Huo J, Wang J, Zhu Y; et al. (2015). "HLA-B*1502 increases the risk of phenytoin or lamotrigine induced Stevens-Johnson Syndrome/toxic epidermal necrolysis: evidence from a meta-analysis of nine case-control studies". Drug Res (Stuttg). 65 (2): 107–11. doi:10.1055/s-0034-1375684. PMID 24871931.
- ↑ Somkrua R, Eickman EE, Saokaew S, Lohitnavy M, Chaiyakunapruk N (2011). "Association of HLA-B*5801 allele and allopurinol-induced Stevens Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis". BMC Med Genet. 12: 118. doi:10.1186/1471-2350-12-118. PMC 3189112. PMID 21906289.
- ↑ McCormack M, Alfirevic A, Bourgeois S, Farrell JJ, Kasperavičiūtė D, Carrington M; et al. (2011). "HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans". N Engl J Med. 364 (12): 1134–43. doi:10.1056/NEJMoa1013297. PMC 3113609. PMID 21428769.
- ↑ Manuyakorn W, Siripool K, Kamchaisatian W, Pakakasama S, Visudtibhan A, Vilaiyuk S; et al. (2013). "Phenobarbital-induced severe cutaneous adverse drug reactions are associated with CYP2C19*2 in Thai children". Pediatr Allergy Immunol. 24 (3): 299–303. doi:10.1111/pai.12058. PMID 23551241.
- ↑ Duncan KO, Tigelaar RE, Bolognia JL (1999). "Stevens-Johnson syndrome limited to multiple sites of radiation therapy in a patient receiving phenobarbital". J Am Acad Dermatol. 40 (3): 493–6. PMID 10071329.