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Background:  The aim of this study was to investigate the predisposition to different types of allopurinol-induced cutaneous adverse drug reactions (CADR), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN; SJS-TEN,  n  = 13), drug reaction with eosinophilia and systemic symptoms (DRESS,  n  = 10) and Maculopapular eruption (MPE;  n  = 7), conferred by  HLA-B  *  58:01  in a Thai population.   Methods:  This case-control association study compares 30 patients with allopurinol-induced CADR, allopurinol-tolerant control patients ( n  = 100), and a Thai general population ( n  = 1095). Patients'  human leukocyte antigen type B (HLA-B)  alleles were genotyped by using a two-stage sequence-specific oligonucleotide probe system.   Results:  Of a total 30 patients with CADR due to allopurinol, 29 (96.7%) patients were found to be at least heterozygous for  HLA-B  *  58:01 , compared to only 4.0% in allopurinol-tolerant patients ( p  < 0.001). Odds ratio (OR) for the association of  HLA-B  *  58:01  with allopurinol-induced CADR in this population was 696.0 (95% CI: 74.8–6475.0). The  HLA-B  *  58:01  allele was present in all patients with allopurinol-induced SJS-TEN (OR = 579.0, 95%CI: 29.5–11362.7,  p  < 0.001) and DRESS (OR 430.3, 95%CI: 22.6–8958.9,  p  < 0.001). Additionally, OR of  HLA-B  *  58:01  was highly significant in the allopurinol-induced MPE patients (OR 144.0, 95%CI: 13.9–1497.0,  p  < 0.001).   Conclusion:  In this study we confirmed the association between  HLAB  *  58:01  and allopurinol-induced SJS-TEN in a Thai population. In addition, we identified an association between  HLA-B  *  58:01  and allopurinol-induced DRESS and MPE in this population. Therefore,  HLA-B  *  58:01  can be used as a pharmacogenetic marker for allopurinol-induced CADR including SJS-TEN, DRESS and MPE. These results suggest that screening for  HLA-B  *  58:01  alleles in patients who will be treated with allopurinol would be clinically helpful in preventing the risk of developing CARD in a Thai patients.   SummaryRegardless of phenotype, this is the first pharmacogenetic study of allopurinol-induced CADR in patients of Thai ancestry.    In this study we confirmed the association between  HLA-B  *  58:01  and allopurinol-induced SJS-TEN, DRESS, and MPE in Thai population.    Regarding to our findings, the pharmacogenetic interpretation could be generalized to drug hypersensitivity including DRESS, SJS-TEN, and MPE.

HLA-B*58:01 for Allopurinol-Induced Cutaneous Adverse Drug Reactions: Implication for Clinical Interpretation in Thailand