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Allopurinol hypersensitivity — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAllopurinol hypersensitivityGPhC CRA

A patient taking allopurinol 300mg daily for gout develops a widespread rash, fever and facial swelling 3 weeks after a dose increase. Blood tests show eosinophilia and ALT above range. What is the most appropriate action?

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Correct answer: D — Stop allopurinol and arrange urgent medical assessment for severe hypersensitivity

Rash with fever, facial swelling, eosinophilia and liver involvement suggests a severe cutaneous adverse reaction or drug hypersensitivity syndrome. Allopurinol should be stopped and urgent medical assessment arranged. Symptomatic antihistamine alone is inadequate. Rechallenge or unsupervised dose reduction would be unsafe.

Reference: BNF; MHRA Yellow Card