Genetic Link Between HLA-A*32:01 and Lamotrigine-Related DRESS: Insights for Clinical Practice

By
Kun Lin Lu
September 2, 2026

Jama Network Open

Objective:

To examine the association between HLA-A*32:01 and lamotrigine-induced drug reaction with eosinophilia and systemic symptoms (DRESS).

Approach:

Study Design: Matched case-control investigation involving a predominantly White cohort from two US centers.
Statistical Analysis: Comparison of HLA-A*32:01 carriage between DRESS cases and lamotrigine-tolerant controls.
Mechanistic Insights: In silico modeling to predict lamotrigine binding to HLA-A*32:01.

Key Findings:

HLA-A*32:01 was present in 41.4% of DRESS cases compared to 4.1% of controls, according to the study.
Carriage of HLA-A*32:01 was associated with increased odds of DRESS (OR, 16.4; 95% CI, 6.4-42.5) as reported in the study.
Concurrent acute liver injury was observed in 69.0% of DRESS cases, but did not differ by HLA-A*32:01 status, as noted in the findings.

Interpretation:

The findings suggest a genetic association between HLA-A*32:01 and lamotrigine-induced DRESS, but the clinical utility of routine screening remains uncertain.

Limitations:

HLA-A*32:01 accounted for only 41.4% of DRESS cases, indicating other genetic factors may be involved, as stated in the study.
The study's sample size limits the ability to evaluate lower-frequency alleles, according to the authors.