A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy
Asia Pacific Allergy
;
(4): 156-163, 2014.
Article
in English
| WPRIM
| ID: wpr-749993
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 16,000 to 13 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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Pyrazinamide
/
Rifampin
/
Complementary Therapies
/
Streptomycin
/
Retrospective Studies
/
Stevens-Johnson Syndrome
/
Drug Eruptions
/
Risk Assessment
/
Asian People
/
Drug Hypersensitivity
Type of study:
Etiology study
/
Observational study
/
Risk factors
Limits:
Humans
/
Male
Language:
English
Journal:
Asia Pacific Allergy
Year:
2014
Type:
Article
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