Schlienger R G, Shear N H
Division of Clinical Pharmacology, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Epilepsia. 1998;39 Suppl 7:S3-7. doi: 10.1111/j.1528-1157.1998.tb01678.x.
The antiepileptic drug hypersensitivity syndrome (AHS) is an adverse drug reaction associated with the aromatic antiepileptic drugs (AEDs) phenytoin (PHT), carbamazepine (CBZ), phenobarbital (PB), and primidone. The syndrome is defined by the triad of fever, skin rash, and internal organ involvement. It can also be caused by other drugs, such as sulfonamides, dapsone, minocycline, terbinafine, azathioprine, and allopurinol. Diagnosis of AHS may be difficult because of the variety of clinical and laboratory abnormalities and manifestations and because the syndrome may mimic infectious, neoplastic, or collagen vascular disorders. The incidence is approximately 1 in 3,000 exposures. AHS starts with fever, rash, and lymphadenopathy, within the first 2-8 weeks after initiation of therapy. Internal manifestations include, among others, agranulocytosis, hepatitis, nephritis, and myostitis. AHS is associated with a relative excess of reactive oxidative metabolites of the AED. Insufficient detoxification may lead to cell death or contribute to the formation of antigen that triggers an immune reaction. Crossreactivity among PHT, CBZ, and PB is as high as 70-80%.
抗癫痫药物超敏反应综合征（AHS）是一种与芳香族抗癫痫药物（AEDs）苯妥英（PHT）、卡马西平（CBZ）、苯巴比妥（PB）和扑米酮相关的药物不良反应。该综合征由发热、皮疹和内脏器官受累三联征定义。它也可由其他药物引起，如磺胺类药物、氨苯砜、米诺环素、特比萘芬、硫唑嘌呤和别嘌醇。由于临床和实验室异常及表现的多样性，且该综合征可能模仿感染性、肿瘤性或胶原血管疾病，AHS的诊断可能会很困难。发病率约为每3000次用药中有1例。AHS在治疗开始后的头2 - 8周内以发热、皮疹和淋巴结病起病。内部表现包括粒细胞缺乏症、肝炎、肾炎和肌炎等。AHS与AEDs的反应性氧化代谢产物相对过量有关。解毒不足可能导致细胞死亡或促成触发免疫反应的抗原形成。PHT、CBZ和PB之间的交叉反应率高达70 - 80%。
