Clinical management of hypersensitivity reactions to antituberculosis drugs
- Author:
Sejin PARK
1
;
Hye-Ryun KANG
Author Information
- Publication Type:REVIEW
- From:Allergy, Asthma & Respiratory Disease 2026;14(1):4-13
- CountryRepublic of Korea
- Language:English
- Abstract: Tuberculosis remains one of the leading causes of death from infectious diseases worldwide, and its effective treatment requires prolonged multidrug regimens. Hypersensitivity reactions to antituberculosis drugs (ATDs) can significantly compromise treatment outcomes. These reactions range from mild skin eruptions to severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. The most frequently implicated agents are pyrazinamide, rifampin, isoniazid, and ethambutol, which are often associated with multiple drug hypersensitivity.Diagnostic tools such as patch testing, intradermal testing, and lymphocyte transformation tests may aid in identifying the culprit drug, but their sensitivity and specificity are limited. In cases of SCARs, immediate discontinuation of the offending agent is essential, and systemic corticosteroids may be effective in moderate to severe cases. Reintroduction of ATDs may be attempted through drug rechallenge or desensitization. Although drug reintroduction was traditionally contraindicated in patients with SCARs, recent reports have demonstrated successful desensitization when performed cautiously with informed consent. Breakthrough reactions may occur during desensitization, but they are often manageable with dose or interval adjustments. The development of standardized desensitization protocols for ATD-induced hypersensitivity remains an important future objective. In addition, ATDs can also induce classical immediate-type reactions such as urticaria and angioedema. In rare cases, they may present as atypical non-IgE-mediated anaphylaxis, for which no definitive diagnostic tools are currently available. Severe reactions may occur upon re-administration and cannot be prevented by desensitization. Thus, careful differential diagnosis is essential and any form of re-exposure is strictly contraindicated.
