Starting dose is a risk factor for allopurinol hypersensitivity syndrome: A proposed safe starting dose of allopurinol
Arthritis & Rheumatism, 04/13/2012
Stamp LK et al. – Starting allopurinol at a dose of 1.5mg per unit eGFR may be associated with a reduced risk of Allopurinol hypersensitivity syndrome (AHS). In patients who tolerate allopurinol the dose can be gradually increased to achieve the target SU.
A retrospective case–control study of patients with gout who developed AHS between January 1998 and September 2010 was undertaken.
For each case, three controls with gout receiving allopurinol who did not develop AHS were identified.
Controls were matched on gender, diuretic use at the time of commencing allopurinol, age ± 10 years, and eGFR. Analysis compared starting dose and dose at the time of the reaction between cases and controls.
Fifty–four AHS cases and 157 controls were identified.
There was an increase in risk of AHS as the starting dose of allopurinol corrected for eGFR increased. For the highest quintile of starting dose≥eGFR, the odds ratio was 23.2 (p<0.01).
ROC analysis indicated that 91% of AHS cases and 36% of controls started on a dose of allopurinol at ≥1.5mg allopurinol per unit eGFR (mg/ml/min).
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