A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy
10.5415/apallergy.2014.4.3.156
- Author:
Bernard Yu Hor THONG
1
;
Faith Li Ann CHIA
;
Sze Chin TAN
;
Teck Choon TAN
;
Khai Pang LEONG
;
Justina Wei Lyn TAN
;
Chwee Ying TANG
;
Jin Feng HOU
;
Grace Yin Lai CHAN
;
Hiok Hee CHNG
Author Information
1. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore. bernard_thong@ttsh.com.sg
- Publication Type:Original Article
- Keywords:
Allergy;
Desensitization;
Drug eruptions;
Drug hypersensitivity syndrome
- MeSH:
Asian Continental Ancestry Group;
Complementary Therapies;
Drug Eruptions;
Drug Hypersensitivity Syndrome;
Drug Hypersensitivity;
Ethambutol;
Exanthema;
Fever;
Humans;
Hypersensitivity;
Isoniazid;
Liver Function Tests;
Male;
Pyrazinamide;
Retrospective Studies;
Rifampin;
Risk Assessment;
Stevens-Johnson Syndrome;
Streptomycin
- From:
Asia Pacific Allergy
2014;4(3):156-163
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Antituberculosis (anti-TB) drug allergy often involves multiple concurrently administered drugs which subsequently need to be reinitiated as no better alternatives exist. OBJECTIVE: To describe the results of tailored sequential desensitization-rechallenge (D-R) for anti-TB drug allergy. METHODS: Consecutive patients who had undergone D-R to anti-TB drugs between 1 September 1997 and 31 January 2012 were recruited. Following resolution of the acute reaction, anti-TB drug was restarted at 1:6,000 to 1:3 of the final daily dose (FDD), with gradual single or multiple step daily dose escalation to the FDD. Subsequent drugs were sequentially added ≥3 days later when the preceding drug was tolerated. Full blood count and liver function tests were monitored prior to addition of each new drug. RESULTS: There were 11 patients of whom 10 were male, predominantly Chinese (8 patients). Regimens comprised at least 3 drugs: isoniazid (INH), rifampicin (RIF), ethambutol (EMB), pyrazinamide (PZA), or streptomycin. All patients had nonimmediate reactions, with cutaneous eruptions, where maculopapular exanthema (MPE) was the most common (8 patients). Drug-induced hypersensitivity syndrome (DIHS) occurred in 6 patients, and Stevens Johnson syndrome (SJS) in 2 patients. D-R to INH was successful in 7/9 patients (77.8%) and to RIF/EMB/PZA/streptomycin in all. Of the 2 patients who failed INH D-R, 1 developed fever and MPE on day 3, the other MPE on day 8. D-R with INH and RIF respectively was successful in 2 patients with SJS. Among DIHS patients, 1 failed D-R with INH (fever and MPE on day 3). There were 23/25 (92%) successful D-R among the 11 patients. All patients completed TB treatment of ≥5 months' duration with no cases of drug-resistant TB. CONCLUSION: Tailored sequential TB drug D-R is successful where no better alternative therapies are available, with careful dose escalation and close monitoring, and after a careful risk-benefit assessment.
