Drug reactions: allopurinol hypersensitivity prevention: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Dermatology · Drug reactions: allopurinol hypersensitivity prevention

Sample item

A 70-year-old with stage 4 chronic kidney disease is started on allopurinol at a standard full dose. Five weeks later he has fever, rash, eosinophilia and hepatitis. Which measure would have lowered the risk?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Low starting dose with gradual titration adjusted to renal function

Allopurinol hypersensitivity syndrome is more frequent with renal impairment, starting a high dose, and HLA-B*58:01. Oxypurinol accumulates in renal failure. Starting low and increasing slowly according to renal function reduces the risk.

Option by option

  • A. Concurrent thiazide diuretic to lower uric acid

    Thiazides raise oxypurinol levels and uric acid, and so increase the risk.

  • B. Taking the dose on an empty stomach

    Taking the dose without food does not alter the risk of hypersensitivity.

  • C. Low starting dose with gradual titration adjusted to renal function (correct)

    Correct. Slow titration from a low dose limits oxypurinol accumulation and hypersensitivity risk.

  • D. Pre-treatment with oral corticosteroids

    Pre-treatment with steroids is not an established method of prevention.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Dermatology questions

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is C, Low starting dose with gradual titration adjusted to renal function. Allopurinol hypersensitivity syndrome is more frequent with renal impairment, starting a high dose, and HLA-B*58:01.

Why is "Concurrent thiazide diuretic to lower uric acid" not the answer?

Thiazides raise oxypurinol levels and uric acid, and so increase the risk.

Why is "Taking the dose on an empty stomach" not the answer?

Taking the dose without food does not alter the risk of hypersensitivity.

Why is "Pre-treatment with oral corticosteroids" not the answer?

Pre-treatment with steroids is not an established method of prevention.

What concept does this question test?

It tests Drug reactions: allopurinol hypersensitivity prevention in Dermatology. Oxypurinol accumulates in renal failure. Starting low and increasing slowly according to renal function reduces the risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Drug reactions: allopurinol hypersensitivity prevention?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.