Abstract
Background: Antiepileptic drugs (AEDs) are widely used for the treatment
of epilepsy, but they can be associated with the development of mainly
delayed/non-immediate hypersensitivity reactions (HRs). Although these
reactions are usually cutaneous, self-limited and spontaneously resolve
within days after drug discontinuation, sometime HRs reactions to AEDs
can be severe and life threatening. Aim: This paper seeks to show
examples on practical management of AEDs HRs in children starting from a
review of what it is already known in literature. Results: Risk factors
include age, history of previous AEDs reactions, viral infections,
concomitant medications and genetic factors. The diagnosis work-up
consists of in vivo (Intradermal testing and Patch testing) and in vitro
tests [serological investigation to exclude the role of viral
infection, lymphocyte transformation test (LTT), cytokine detection in
ELISpot assays and granulysin (Grl) in flow cytometry]. Treatment is
based on a prompt drug discontinuation and mainly on the use of
glucocorticoids. Conclusion: Dealing with AEDs HRs is challenging. The
primary goal in the diagnosis and management of HRs to AEDs should be
trying to accurately identify the causal trigger and simultaneously
identify a safe and effective alternate anticonvulsant. There is
therefore an ongoing need to improve our knowledge of HS reactions due
to AED medications and in particular to improve our diagnostic
capabilities.