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March 27, 2019

Screening HLA to Prevent Severe Drug Reactions—A Devil’s Advocate Perspective

Author Affiliations
  • 1Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2019;155(6):655-656. doi:10.1001/jamadermatol.2018.5336

Severe cutaneous adverse [drug] reactions (SCARs) are delayed-onset drug hypersensitivity reactions that carry significant morbidity and mortality and impose a major economic burden on health care systems.1,2 The year 2002 heralded a breakthrough in SCAR and pharmacogenomics research with the discovery that the allele HLA-B*57:01 is strongly associated with abacavir-induced drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS), a type of SCAR.3 In 2008, Mallal et al4 published evidence that supported screening patients with HIV for HLA-B*57:01 prior to initiating abacavir treatment to prevent DIHS/DRESS. The field has since exploded, with dozens of HLA-drug associations identified in the context of specific drug reactions.5,6 As a result, a growing number of studies aimed at evaluating the utility of screening HLA to prevent SCAR are being performed. A recent systematic review highlighted the association between dapsone-induced SCAR and HLA-B*13:01.7 In this issue of JAMA Dermatology, Liu et al8 demonstrate that screening for HLA-B*13:01 prior to initiating dapsone therapy for patients with leprosy in China prevented DIHS/DRESS, thus supporting a role for HLA screening.

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