Management of type 1 immediate hypersensitivity reactions to antituberculosis drug: succesful desensitization

Abstract

Objective In this study, it was aimed to investigate the prevalence of type 1 hypersensitivity reaction under tuberculosis treatment and the management of hypersensitivity. Methods The study is a case series. All of the patients who were hospitalized between 01.02.2015–01.05.2021 were examined. All patients who developed a drug-induced type 1 immediate hypersensitivity reaction were included. Antituberculosis drugs were given with the protocol made by Buhari et al. However, unlike what is stated in the protocol, pyrazinamide was given last during the administration of the drugs. Results 2677 patients received inpatient tuberculosis treatment; type 1 immediate hypersensitivity reactions were seen in 94 (3.5%) patients. Due to missing data in the file, 81 patients were included in the study. 44 (54.3%) of the cases were women; mean age (mean ± SD) 50.7 ± 17.69 years; 76 (93.8%) of them are citizens of the Republic of Turkey; 58 (71.6%) of them were diagnosed bacteriologically; 65 (80.2%) of them were pulmonary tuberculosis. The most common skin finding was urticaria in 49 (60.5%). The drug responsible for the most common reaction was pyrazinamide. In 49 (60.5%) cases, drugs were given by desensitization and it was successful. The duration of treatment was 7.91 ± 2.5 months (6–18 months). When evaluated in terms of treatment results, 68 (84%) patients successfully completed the treatment. Conclusion Our study is the largest series of patients who developed type 1 immediate hypersensitivity reaction while receiving antituberculosis treatment. A practical, easy desensitization scheme has been shared.

Hypersensitivity reactions with first-line antituberculosis drugs and outcomes of rapid desensitizations

“…Multiple drug hypersensitivity was reported at a substantial level with antituberculosis drugs. 11 , 13 , 14 , 15 , 16 , 17 , 18 , 29 In our study, BTRs with multiple drugs were detected in 16 of 76 (21.1%) patients, and one patient had BTRs with all first-line antituberculosis drugs. Smadhi et al.…”

“…Besides there are reports of skin test positivity as an evidence of sensitization and IgE-mediated DHR with antituberculosis drugs. 28 , 29 , 30 , 31 We did not perform skin tests in this study because our aim was not to identify the culprit drug but to provide rapid and effective management of patients and also, as a parenteral drug required for performing intradermal tests only the parenteral form of R is available in our country. Further studies are required to elucidate the mechanisms of immediate-type DHRs with antituberculosis drugs.…”

“… 4 , 5 , 6 , 7 , 15 , 35 , 36 Considering the studies in which the majority of the study group consisted of patients compatible with immediate-type DHR, Smadhi et al reported Z as the most common culprit after reintroduction, and Katran et al reported Z as the most common culprit of BTRs during desensitizations. 17 , 29 However in a study reporting adverse drug reactions to first-line antituberculosis drugs in 17 843 cases, R was the most common culprit of common adverse reactions and also DHRs such as rash, pruritus, urticaria, fever, eosinophilia, and dyspnea. 27 In our study Z was found to be the most common culprit of BTRs with a BTR development rate of 32.4% and had the lowest desensitization success after a BTR (71.4%).…”

“…Katran et al reported that HRZE was started without any problems in 49 of 81 (60.5%) patients with mild immediate reaction. 29 In addition to be successful, these protocols are also advantageous because of their short implementation time.…”

CNS tuberculoma in an immunocompetent patient: A case report of multi-drug hypersensitivity to RIPE therapy

“…Though RIPE is the mainstay of tuberculosis treatment worldwide in non-multidrug resistant TB cases, it is important to remember 3–4 % of patients develop hypersensitivity reactions to therapy [16] . Furthermore, 48 % of patients who experience a drug hypersensitivity reaction to RIPE are hypersensitive to more than one of the RIPE drugs, which is much higher than the 2.5 % of patients who experience multiple-drug hypersensitivity in the general population [17] .…”