| HLA‒B*58:01 and skin reactions in pediatric hematology
and oncology patients treated with allopurinol |
Parisa Maneechai1 
, Cholada Ratanatharathron2
, Jassada Buaboonnam1
, Kleebsabai Sanpakit1
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1Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2Pharmacy Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand |
Correspondence:
Kleebsabai Sanpakit, Email: kleebsabai.sap@mahidol.ac.th
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Received: 7 May 2025 • Revised: 21 July 2025 • Accepted: 21 July 2025 |
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| Abstract |
Background
Allopurinol is widely used to prevent
hyperuricemia in patients with tumor lysis syndrome.
However, its use can trigger severe cutaneous adverse
reactions (SCARs) with a mortality rate of approximately
11.39%. The human leukocyte antigen (HLA)–B*58:01
genotype is a major risk factor for SCARs. Although most
studies to date have examined HLA–B*58:01 in Thai adults,
data on pediatric patients are limited.
Purpose
Here we aimed to evaluate the association
between HLA-B*58:01 and skin reactions in children with
hematological or oncological diagnoses receiving allopurinol
and determine its prevalence in this population.
Methods
Pediatric patients (age≤18 years) with hematological
or oncological diseases who received allopurinol
were enrolled in this cross-sectional study of previously
exposed and newly prescribed cases. HLA-B*58:01 genotyping
was performed to assess its association with skin
reactions.
Results
A total of 108 patients (mean age, 9.3 years) were
included. Most patients (n=93, 86.1%) received allopurinol
as prophylaxis for tumor lysis syndrome. Of them, 75
(69.4%) received allopurinol concomitantly with chemotherapy
for malignancies, whereas the remaining patients
received allopurinol during conditioning for hematopoietic
stem cell transplantation. The prevalence of
HLA–B*58:01 positivity was 17.6% (n=19 of 108 patients). The
median exposure
duration was 5 days (range, 1-19 days). No
HLA–B*58:01–positive patients experienced a skin reaction.
However, one patient who tested negative for HLA-B*58:01
developed a maculopapular rash on day 2 of the allopurinol
therapy and required intravenous antihistamines.
Conclusion
Short-duration allopurinol exposure likely
mitigates the risk of SCARs regardless of HLA–B*58:01
status. Routine HLA-B*58:01 testing may not be warranted
in pediatric patients receiving brief allopurinol courses.
However, larger studies are required to confirm these
findings. |
| Key Words:
Allopurinol, HLA–B*58:01, Skin reaction |
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