T. Sheriff, B. Daniel, D.F. Murrell
Introduction: Allopurinol-induced DRESS (drug reaction with eosinophilia and systemic symptoms), is strongly associated with the expression of Human Leucocyte Anti- gen (HLA)-B* 58:01. HLA-B*58:01 is commonly expressed in people of Asian descent. We present a case of a 90- year-old gentleman of Han Chinese descent with Allop- urinol induced Dress (A-DRESS) and kidney and renal impairment who tested positive to HLA-B*58:01 to high- light the importance and potential utility of pre-treatment testing of HLA-B*58:01 in Asian patients. The authors also summarized the literature on the incidence and health care associated costs of patients with DRESS syn- drome.
Methods: A literature search was performed on PubMed and Medline Databases using search terms;
•DRESS and Allopurinol
•DRESS and HLA-B*58:01
A total of 118 articles were found and 14 were selected based on relevance, publication date < 5 years and study design. Results: DRESS has a mortality rate of 10% with an inci- dence of 2.18 per 100,000 people in the United States, among 3.3 million patients with recorded allergies. The median length of stay is 9 days and cost of admission is $17,000USD per patient. The cost of HLA-B*58:01 genotyp- ing in New South Wales is $75 AUD and is not subsidized by Medicare. Conclusion: Pre-treatment testing of HLA-B*58:01 is rec- ommended in high risk populations about to commence allopurinol to reduce the risk of mortality and admission costs of A-DRESS