The Food and Drug Administration (FDA) has issued an alert that carbamazepine may increase the risk of Stevens-Johns syndrome and toxic epidermal necrolysis more in Asian patients than in patients of other ancestry. That's because the human leukocyte antigen (HLA) allele that leads to these serious or fatal skin reactions occurs almost always in patients with ancestry across broad areas of Asia, including south-Asian Indians and patients from parts of China, Thailand, Malaysia, Indonesia, the Philippines, Taiwan, and possibly Japan and Korea.
   Genetic tests for the allele (HLA-B* 1502) are available, and patients of Asian ancestry should be screened before starting carbamazepine therapy. Those who test positive, FDA officials warn, shouldn’t start taking carbamazepine unless the expected benefits clearly outweigh the increased risk of serious skin reactions. These patients may have an increased risk of Stevens-Johnson syndrome and toxic epidermal necrolysis from other antiepileptics as well.
   Patients of any ancestry who take carbamazepine uneventfully for a few months have a low risk of skin reactions, although they may still occur.

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