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Tais Hitomi Wakamatsu, Mayumi Ueta, Renata Ruoco Loureiro, Kárita Antunes Costa, Juliana M F Sallum, Chie Sotozono, Shigeru Kinoshita, José Alvaro Pereira Gomes; Association of HLA-B*44:03 with Stevens-Johnson syndrome in Brazilian patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5993.
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To investigate the etiologic factors that have been implicated as causes of Stevens-Johnson syndrome and the prevalent HLA class I - B gene.
Seventy-four patients with SJS/NET with severe ocular surface complications (41 females; 32 males; age range 7 months to 70 years; mean age, 36,01 ± 15,42) recruited at Federal University of São Paulo were enrolled in this study. The age range at onset was 3 to 69 years and the mean age at onset, 23,05 ± 15,85. The study ethnicity was variable: pardo, n = 38 (51%); white, n = 30 (40%); black, n = 4 (6%); Indian plus white, n = 2 (3%). Healthy Brazilian volunteers (n=134) served as the controls. We performed polymerase chain reaction assay followed by hybridization with sequence-specific oligonucleotide probe using commercial bead-based typing kits.
Drugs are most often implicated as the etiology in adults. Cold medicines including non-steroidal anti-inflammatory drugs, multi-ingredient cold medications and anti-pyretic medicines are reported to be important inciting causative factors. In our study this group of medication was also the main SJS causative drug totalizing 53% of the patients. The second most important group of medication was the anti-convulsant (15%, including Phenobarbital, n = 5; Carbamazepim, n = 3 and Phenytoin, n = 3). The etiology of SJS in five patients was unknown. HLA class I B analysis showed HLA-B44:03 as the most prevalent allele, with a gene frequency of 19/148 (12.8%) and a carrier frequency of 18/74 (24,3%). There was a significant association between patients with SJS/NET and HLA-B*44:03 (carrier frequency: p = 0.0224, OR = 2.550, gene frequency: p=0.0167, OR = 2.484). Considering all patients with a HLA-B*44:03 allele we could observed that 66.67% had SJS/NET caused by cold medicine and 5.55% caused by anti-convulsant.
We found that HLA-B*44:03 was significantly associated with SJS/NET and the main causative drug of these diseases was cold medicine.
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