ABSTRACT
INTRODUCTION: para-Aminosalicylic acid (PAS) is commonly used in the treatment of drug-resistant tuberculosis, including multidrug-resistant tuberculosis. Since its first use in the 1940s, hypersensitivity reactions frequently limit its use in clinical practice. Cases of successful desensitization against PAS using orally administered ascending doses are described in the literature. CASE REPORT: A 25-year-old patient with severe pulmonary multidrug-resistant tuberculosis developed drug fever with rash, acral cyanosis, and shivering immediately after the intravenous application of PAS. Hard gelatine capsules containing PAS dry substance were prepared in order to desensitize this patient. Encapsulated PAS was applied orally in rising doses starting with 10 mg/day and doubling the dose every 2 days until the half-maximal dose of 5,120 mg was reached. Desensitization covers a period of 21 days. Subsequent intravenous application of PAS at the full dose was well tolerated. In a 12-month follow-up period, no more allergic reactions appeared. CONCLUSIONS: PAS dry substance encapsulated in hard gelatine capsules and administered orally in rising concentrations may be useful to archive a successful desensitization for subsequent intravenous applications.
Subject(s)
Aminosalicylic Acid/administration & dosage , Antitubercular Agents/administration & dosage , Desensitization, Immunologic , Tuberculosis, Pulmonary/drug therapy , Adult , Aminosalicylic Acid/adverse effects , Aminosalicylic Acid/immunology , Antitubercular Agents/adverse effects , Antitubercular Agents/immunology , Capsules , Dose-Response Relationship, Immunologic , Female , Follow-Up Studies , Gelatin , Humans , Injections, Intraventricular , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/immunology , Tuberculosis, Pulmonary/immunologyABSTRACT
SETTING: Tertiary care hospital in the Upper Midwest, United States. OBJECTIVE: Rapid desensitization to para-aminosalicylic acid (PAS) in a patient with previous hypersensitivity reaction and a review of published PAS desensitization protocols. DESIGN: Composition and implementation of a short-course PAS desensitization protocol for a 34-year-old woman with multidrug-resistant (MDR) pulmonary tuberculosis, incorporating published experiences of PAS desensitization over the past 50 years. RESULTS: We composed a protocol and successfully desensitized our patient to PAS (Paser granules). By starting with a low dose (50 mg), then doubling the PAS dose on each successive day, our patient was able to tolerate full dose in 1 week. No steroids were required and no adverse reactions were encountered. Previous published PAS desensitization protocols used starting doses of 10-500 mg, desensitization time ranges from 7 to 54 days and commonly used steroids or corticotropin. CONCLUSION: Rapid desensitization to PAS can be successfully conducted within 1 week without the use of steroids or corticotropin. Given the limited number of drugs available for many patients with MDR-TB, desensitization to PAS is a valid alternative to drug discontinuation for patients with hypersensitivity reactions.
Subject(s)
Aminosalicylic Acid/immunology , Antitubercular Agents/immunology , Desensitization, Immunologic , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Pulmonary/drug therapy , Adult , Aminosalicylic Acid/administration & dosage , Antitubercular Agents/administration & dosage , Female , Humans , Tuberculosis, Multidrug-Resistant/immunology , Tuberculosis, Pulmonary/immunologyABSTRACT
Polarisation fluorescence was used to assess the antibody response in sheep immunised with 4-aminosalicylic acid coupled to keyhole limpet haemocyanin and to develop a polarisation fluoroimmunoassay for subsequent clinical use. The fluorescent label was prepared by coupling 4-aminosalicylic acid to fluorescein isothiocyanate. All immunised sheep produced antibodies and a simple assay was developed using salicylic acid as the standard. The simple fluorescence polarisation approach enabled the rapid and direct study of the immuno-reactivity of a large number of pure chemical analogues of salicylic acid. Each was assessed for its ability to compete with the fluorophore-labelled analyte for antibody-binding sites, relative to salicylate, thereby enabling investigation of the steric and chemical characteristics important in the recognition and binding of a hapten to antibodies.
Subject(s)
Aminosalicylic Acid/immunology , Aminosalicylic Acids/immunology , Antibodies/immunology , Animals , Antibody Formation , Cross Reactions , Epitopes , Fluorescence Polarization , Immunoassay/methods , Reference Standards , Salicylates/immunology , Salicylic Acid , SheepABSTRACT
The literature has been reviewed for contact dermatitis occurring to antituberculosis agents. Of the 12 known drugs, 6 (isoniazid, rifampicin, ethambutol, para-aminosalicylic acid, streptomycin and kanamycin) have been documented by patch test to cause this type of dermatitis in certain individuals. Cross sensitization has been observed to contribute significantly to the allergic reactions noted from isoniazid, streptomycin, and kanamycin. Hyposensitization has also been discussed in this review.
