This Asian allopurinol dosing article is about the risk of developing serious skin reactions to allopurinol in Asian ethnic groups. I will publish similar articles for Black or African American ethnic groups, for Caucasian ethnic groups, and for others including Hispanic, Latino, and Middle Eastern.
If you are currently taking allopurinol without serious skin problems, then this article is irrelevant. If you are not controlling uric acid, you should not be put-off by risks of reactions to drugs. There are alternatives to allopurinol, but there is no alternative to lowering uric acid. It is dangerous to ignore high uric acid. Even when you are not in pain, uric acid crystals will grow slowly, eventually causing permanent damage to skin, kidneys, heart, and other organs.
Asian Allopurinol Dosing Introduction
In October 2012, the American College of Rheumatology (ACR) introduced new gout guidelines. This led me to explain how to minimize allopurinol side effects. Those ACR guidelines identify Korean, Han Chinese, and Thai racial groups as highest risk groups of severe allopurinol rash. Therefore, they recommend screening for the specific genetic variant (HLA-B*5801) prior to allopurinol dosing.
New research goes much deeper into this specific problem. Because it explains which ethnic groups have been identified as most at risk. The resulting guidelines explain that their work is not complete, and other groups may still need testing. However, they point out that 100 mg allopurinol starting dose will not usually cause very severe reactions.
If existing allopurinol dosing recommendations are followed correctly, allopurinol continues to be the safest option for most gout patients. This means starting at 100mg, and increasing dose based on uric acid test results, stopping if serious rash occurs, or if liver function test results show serious anomalies.
Your doctor should be aware of the screening procedures. I will summarize the latest guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC) separately. Before that, I present tables of the ethnic groups affected, starting with Asian races.
Asian Allopurinol Dosing Risks
Please note that these are risk statistics. Do not worry if you are currently taking allopurinol and belong to a high risk ethnic group. These risk factors are published to allow doctors to recommend the best treatment choices. Now that alternatives to allopurinol exist, it makes most sense to screen high risk groups, and prescribe Uloric if you are affected by the specific gene.
|Ethnicity||HLA-B*5801 frequency (%)||Sample Size|
|China Guangdong Province Meizhou Han||17||100|
|Taiwan Han Chinese||10.6||504|
|Taiwan pop 3||10.1||212|
|Taiwan pop 2||10||364|
|Taiwan Tzu Chi Cord Blood Bank||9.8||710|
|China Canton Han||8.9||264|
|China South Han||8.9||284|
|China Inner Mongolia Region||8.8||102|
|Taiwan Minnan pop 1||8.8||102|
|China Guizhou Province Bouyei||8.3||109|
|Thailand Northeast pop 2||7.9||400|
|China Southwest Dai||7.7||124|
|China Yunnan Province Han||7.4||101|
|Hong Kong Chinese||7.3||569|
|India Andhra Pradesh Golla||7.2||111|
|Russia Tuva pop 2 Siberian||6.7||169|
|South Korea pop 3||6.5||485|
|Vietnam Hanoi Kinh pop 2||6.5||170|
|China Beijing Shijiazhuang Tianjian Han||6||618|
|Indonesia Sundanese and Javanese||6||201|
|Indonesia Java Western||5.9||236|
|USA Asian pop 2||5.7||1772|
|Singapore Riau Malay||5||132|
|China Guangzhou Han||4.7||106|
|China Guangxi Region Maonan||4.2||108|
|China North Han||2.9||105|
|China Yunnan Province Hani pop 2||2.7||150|
|China Qinghai Province Hui||2.3||110|
|China Yunnan Province Nu||1.9||107|
|China Yunnan Province Wa||1.7||119|
|China Tibet Region Tibetan||1.6||158|
|China Guizhou Province Shui||1.5||153|
|China Yunnan Province Lisu||0.7||111|
|China Yunnan Province Jinuo||0.5||109|
|Japan pop 3||0.5||1018|
|China Yunnan Province Bulang||0.4||116|
If this is unavailable, please ask for a copy in the gout forums.
Asian Allopurinol Dosing: Next Steps
Allopurinol is recommended by rheumatologists as the first choice treatment for uric acid lowering, due to its low cost and long safety history. The biggest obstacle is the risk of allopurinol rash, or as this report describes it: Severe Cutaneous Adverse Reactions (SCAR). By identifying those people most at risk of SCAR, doctors can offer more suitable treatment, such as Uloric, whilst retaining the best treatment for those not at high risk.
I will present data for other ethnic groups soon, so please ensure you do not miss it by subscribing to my free gout update service. If you need help before I publish the rest of the allopurinol dosing study, please ask in the gout forum. Please note, that link takes you to the form to post a new question, but for best responses you should search to see if we are already discussing Asian allopurinol dosing using the box above or below.
Leave Asian Allopurinol Dosing to browse the Minimize Allopurinol Side Effects guidelines.