Clinical Rheumatology

, Volume 33, Issue 6, pp 873–875

Flow cytometry test to screen for HLA-B*58:01-associated allopurinol hypersensitivity

  • Mirko Scarsi
  • Carla Bosio
  • Silvia Coccoli
  • Amilcare Barucco
  • Giovanna Tavelli
  • Paolo Airò
Case Based Review

DOI: 10.1007/s10067-014-2605-3

Cite this article as:
Scarsi, M., Bosio, C., Coccoli, S. et al. Clin Rheumatol (2014) 33: 873. doi:10.1007/s10067-014-2605-3

Abstract

A strong association between the human leucocyte antigen (HLA)-B*58:01 allele and allopurinol-associated severe cutaneous adverse reactions (SCAR) has been reported. A screening for HLA-B*58:01 before allopurinol has been suggested in guidelines for management of gout. HLA-B*58:01 screening is generally based on molecular biology methods that may be not suitable for wide application. We have retrospectively evaluated the performance on a rapid flow cytometry (FCM) test, based on the use of a monoclonal antibody specific for HLA-B17, an antigen that can be split into HLA-B*57 and –B*58 alleles by molecular biology testing, which is used to screen for HLA-B*57:01 before prescription of the antiretroviral agent abacavir in HIV-positive patients. Among 475 samples that were analysed by FCM and by molecular biology test as gold standard, 2 out of 89 false negative tests for HLA-B*58:01 were found. The sensitivity was 97.8 % and the negative predictive value was 98.9 %. We have shown that a FCM test can identify almost all HLA-B*58:01 positive individuals. As FCM laboratories are more widely available than molecular biology ones, this approach could be used to reduce the risk for allopurinol-induced SCAR. Where both facilities are available, a two-step strategy (FCM as screening, molecular biology for confirmation) may reduce the cost of the screening.

Keywords

Allopurinol Gout HLA-B*58:01 Severe cutaneous adverse reactions 

Copyright information

© Clinical Rheumatology 2014

Authors and Affiliations

  • Mirko Scarsi
    • 1
  • Carla Bosio
    • 1
  • Silvia Coccoli
    • 1
  • Amilcare Barucco
    • 1
  • Giovanna Tavelli
    • 1
  • Paolo Airò
    • 1
  1. 1.Rheumatology and Clinical Immunology UnitSpedali Civili and University of BresciaBresciaItaly

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