{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T20:52:42Z","timestamp":1792356762860,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2012,7,27]],"date-time":"2012-07-27T00:00:00Z","timestamp":1343347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatism"],"published-print":{"date-parts":[[2012,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Allopurinol is the most commonly used urate\u2010lowering therapy in gout. Allopurinol hypersensitivity syndrome (AHS) is a rare but potentially fatal adverse event. Dosing guidelines based on creatinine clearance have been proposed based on the recognition that dosages of \u2265300 mg\/day may be associated with AHS, particularly in patients with renal impairment. However, the relationship between the allopurinol starting dose and AHS is unknown. This study was undertaken to determine the relationship between allopurinol dosing and AHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective case\u2013control study of patients with gout who developed AHS between January 1998 and September 2010 was undertaken. For each case, 3 controls with gout who were receiving allopurinol but did not develop AHS were identified. Controls were matched with cases for sex, diuretic use at the time of initiating allopurinol, age (\u00b110 years), and estimated glomerular filtration rate (estimated GFR). Starting dose and dose at the time of the reaction in cases were compared between cases and controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010four AHS cases and 157 controls were identified. There was an increase in the risk of AHS as the starting dose of allopurinol corrected for the estimated GFR increased. For the highest quintile of starting dose per estimated GFR, the odds ratio was 23.2 (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.01). Receiver operating characteristic analysis indicated that 91% of AHS cases and 36% of controls received a starting dose of allopurinol of \u22651.5 mg per unit of estimated GFR (mg\/ml\/minute).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings indicate that starting allopurinol at a dose of 1.5 mg per unit of estimated GFR may be associated with a reduced risk of AHS. In patients who tolerate allopurinol, the dose can be gradually increased to achieve the target serum urate level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.34488","type":"journal-article","created":{"date-parts":[[2012,4,5]],"date-time":"2012-04-05T13:10:29Z","timestamp":1333631429000},"page":"2529-2536","source":"Crossref","is-referenced-by-count":253,"title":["Starting dose is a risk factor for allopurinol hypersensitivity syndrome: A proposed safe starting dose of allopurinol"],"prefix":"10.1002","volume":"64","author":[{"given":"Lisa K.","family":"Stamp","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter B.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo L.","family":"Dockerty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Drake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Frampton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Dalbeth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,7,27]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.20405"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780341203"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.10511"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.20102"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.055269"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.40.3.245"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/106002809302700317"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-197911000-00004"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(79)70031-4"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0409500102"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.2217\/14622416.9.11.1617"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/FPC.0b013e328330a3b8"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/FPC.0b013e3282f3ef9c"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2007.00270.x"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.60.10.981"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(84)90743-5"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-130-6-199903160-00002"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.331.7517.623"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.30119"},{"key":"e_1_2_7_21_2","doi-asserted-by":"crossref","first-page":"616","DOI":"10.2340\/00015555-0528","article-title":"HLA\u2010B allele associations with certain drugs are not confirmed in Japanese patients with severe cutaneous drug reactions","volume":"88","author":"Kano Y","year":"2008","journal-title":"Acta Derm Venereol"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfr060"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/26.6.445"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2011.113"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(76)90179-0"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1006\/clin.1994.1022"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-95-5-588"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780310318"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kem056a"},{"key":"e_1_2_7_30_2","first-page":"1646","article-title":"Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricaemia in patients with gout","volume":"33","author":"Dalbeth N","year":"2006","journal-title":"J Rheumatol"},{"key":"e_1_2_7_31_2","first-page":"2429","article-title":"Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis","volume":"31","author":"Borstad GC","year":"2004","journal-title":"J Rheumatol"}],"container-title":["Arthritis &amp; 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