A systematic review of isotretinoin and its contraindications in peanut, soybean and cashew nut allergies

Abstract

Should oral isotretinoin be considered contraindicated in patients with peanut, soybean, and cashew allergies? A systematic literature search of PubMed, EMBASE and The Cochrane Library up to July 2023 was conducted to identify randomised control trials (RCTs), cohort studies, case reports, and cross-sectional studies investigating if isotretinoin should be contraindicated in patients with various allergies including peanut, soybean, and cashew allergies. Primary outcomes explored included relapse, adverse effects, and safety profiles of oral isotretinoin at varying doses. Secondary outcomes included efficacy as well as economic considerations. The quality of studies, including risk of bias, was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). A total of eight studies were included. The majority of studies suggested that isotretinoin should not be considered inadvisable. In cases with peanut allergies, minimal adverse effects were noted with various dosages of isotretinoin and prolonged treatment duration. In cases with soybean allergies, similar results and conclusions were obtained to the cases with peanut allergies, however the number of studies were not of similar value to those of peanut allergies. Comparison between studies was challenging due to differing methods of assessment, subjective interpretation of severity and duration of follow-up. This review highlights the need for an adequately powered RCT, to decipher whether isotretinoin should not be given to patients with peanut, soybean or cashew allergies.