Asia Pac Allergy.  2014 Jul;4(3):156-163. 10.5415/apallergy.2014.4.3.156.

A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy

• Thong BY
• Chia FL
• Tan SC
• Tan TC
• Leong KP
• Tan JW
• Tang CY
• Hou JF
• Chan GY
• Chng HH

• KMID: 2397093
• DOI: http://doi.org/10.5415/apallergy.2014.4.3.156

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.

Keyword

Allergy; Desensitization; Drug eruptions; Drug hypersensitivity syndrome

MeSH Terms

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
Ethambutol
Isoniazid
Pyrazinamide
Rifampin
Streptomycin

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