Allopurinol desensitization with A 2 weeks modified protocol in an elderly patients with multiple comorbidities: A case report

Dursun A. B., ŞAHİN Ö. S.

Allergy, Asthma and Clinical Immunology, vol.10, no.1, 2014 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 10 Issue: 1
  • Publication Date: 2014
  • Doi Number: 10.1186/1710-1492-10-52
  • Journal Name: Allergy, Asthma and Clinical Immunology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Keywords: Allopurinol hypersensitivty, Gout, Hyperuricemia, Maculopapular exanthema, Oral drug desensitization, Slow desensitization
  • Lokman Hekim University Affiliated: No


Background: Allopurinol is an effective urate-lowering drug that is well tolerated by the majority of patients. Patients with chronic renal insufficiency have an increased risk of hypersensitivity reactions with allopurinol. Case presentation: 75 year old male patient with gout, renal insufficiency, history of metastatic colorectal carcinoma status post-resection was referred to Allergy clinic for a maculopapular eruption that developed 1 week after initiating therapy with allopurinol. The rash resolved with discontinuation of allopurinol. However, his serum urate level rose to 19.9 mg/dl. We initially proposed a slow 4 week oral allopurinol desensitization. The treating nephrologist felt it was critical to lower urate more rapidly. As a result, we modified the dose and standard 4 week protocol down to 2 weeks. A suspension of allopurinol was prepared by the allergy nurse practitioner with a 300 mg allopurinol tablet. The sensitization protocol was modified as a starting dose of 0.3 mg escalating to a final dose of 300 mg/day in 2 weeks. There was no reaction during or after the desensitization. The patient's urate level normalized (6.3 mg/dl) and has continued on 300 mg allopurinol daily without reaction. Conclusion: A 2 week modified allopurinol desensitization protocol is a safe alternative for elderly patients with multiple comorbidities.