What are the racial predilections for toxic epidermal necrolysis (TEN)?

Updated: Jul 01, 2021
  • Author: Samantha P Jellinek-Cohen, PharmD, BCPS (AQ-ID); Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

A genetic predilection toward carbamazepine-induced TEN has been observed in HLA-B*1502–positive patients in mainland southeast Asian people from China to India. The US Food and Drug Administration recommends screening for the HLA-B*1502 allele before initiating carbamazepine in patients of Asian ancestry. [24]  The HLA-B*58:01 allele is associated with allopurinol-induced TEN in Han Chinese people. HLA-A*66:01, HLA-B*44:03, and HLA-C*12:03 have been associated with cold medicine-TEN with severe ocular complications in patients who had taken cold medicines in the 1-14 days prior to onset of the disease. The HLA-B*44:03 (odds ratio, 5.50) and HLA-C*12:03 (OR, 8.79) alleles were associated with a less-robust tisk of cold medicine-TEN only in European patients. [25]

Registration databases from Tawain, Thailand, Japan, Malaysia, Singapore, Hong Kong, the Philippines, and mainland China (Fujian) identified that from 1998-2017, greater than 50% of cases of SJS/TENS involved carbamazepine, allopurinol, phenytoin, lamotrigine, and sulfamethoxazole.  Oxacarbazepine, sulfasalazine, COX-II inhibitors, and strontium ranelate (not approved by the Food and Drug Administration but used in more than 70 countries as a treatment option for postmenopausal osteoporosis) have been identified as potential new causes of SJS/TENS in Asian patients.  Other medications known to cause SJS/TENS such as oseltamavir, terbinafine, and sorafenib, were not associated with any cases in Asian patients enrolled in these databases. [26]


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