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Pharmacogenomics and Cutaneous Adverse Drug Reactions

  • Ren-You Pan
  • Chun-Bing Chen
  • Wen-Hung ChungEmail author
Chapter

Abstract

Cutaneous adverse drug reactions (cADRs) are unpredictable and may range from mild maculopapular exanthema (MPE) to life-threatening severe cutaneous adverse drug reactions (SCARs), including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Increasing pharmacogenomic studies showed specific HLA alleles are strongly associated with cADRs. The pathogenic checkpoints of cADRs include genetic polymorphisms affecting the immune synapse of HLA/drugs/T cell receptor interactions, specific HLA loci, T cell-mediated responses, and drug metabolism. Recently, pharmacogenomic screening for specific HLA alleles or high-risk genes prior to drug prescriptions to prevent cADRs has been widely implemented in clinical practice.

Keywords

Cutaneous adverse drug reactions (cADRs) Drug reaction with eosinophilia and systemic symptoms (DRESS) Human leukocyte antigen (HLA) Stevens-Johnson syndrome (SJS) T cell receptors (TCR) Toxic epidermal necrolysis (TEN) 

Abbreviations

cADRs

Cutaneous adverse drug reactions

CBZ

Carbamazepine

CYP2C9*3

Cytochrome P450 family 2 subfamily C member 9*3

DRESS

Drug reaction with eosinophilia and systemic symptoms

HLA

Human leukocyte antigens

HSS

Hypersensitivity syndrome

LTG

Lamotrigine

MPE

Maculopapular exanthema

OXC

Oxcarbazepine

PHT

Phenytoin

SCAR

Severe cutaneous adverse reactions

SJS

Stevens–Johnson syndrome

TCR

T cell receptors

TEN

Toxic epidermal necrolysis

Notes

Acknowledgments

Source of Funding: This work was supported in part by grants from the Ministry of Science and Technology, Taiwan (MOST 104-2314-B-182A-148-MY3, MOST 104-2325-B-182A-006, MOST 106-2314-B-182A-037-MY3), and Chang Gung Memorial Hospital (CLRPG2E0051~3, CORPG3F0041~2).

Conflict of Interest: The authors report no disclosures relevant to the manuscript.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Ren-You Pan
    • 1
    • 2
  • Chun-Bing Chen
    • 1
    • 2
    • 3
    • 4
    • 5
  • Wen-Hung Chung
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Dermatology, Drug Hypersensitivity Clinical and Research CenterChang Gung Memorial Hospital, LinkouTaipeiTaiwan
  2. 2.Chang Gung Immunology ConsortiumChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  3. 3.Whole-Genome Research Core Laboratory of Human DiseasesChang Gung Memorial HospitalKeelungTaiwan
  4. 4.Graduate Institute of Clinical Medical Sciences, College of MedicineChang Gung UniversityTaoyuanTaiwan
  5. 5.Department of DermatologyXiamen Chang Gung HospitalXiamenChina

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