Lee et al made a number of recommendations for avoiding the allopurinol-related drug rash with eosinophilia and systemic symptoms (DRESS). This is a potentially life-threatening illness that must be taken very seriously. The authors are from Singapore General Hospital.


Synonyms: allopurinol hypersensitivity syndrome (AHS)


Risk factors for allopurinol-related DRESS:

(1) Chinese race (at least in Singapore where the study was performed)

(2) renal insufficiency

(3) older age (>= 65 years of age)


Recommendations for avoiding allopurinol-related DRESS:

(1) Only prescribe allopurinol when there is a clear indication.

(2) Be careful when treating a patient with one or more risk factors.

(3) Adjust the dose if the patient has renal insufficiency.

(4) Monitor the patient closely for signs and symptoms of a hypersensitivity reaction, especially for the first 2 months of therapy.

(5) Educate the patient about the signs of a hypersensitivity reaction and the need to contact the physician immediately.


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