Allergy Asthma Respir Dis AARD Allergy, Asthma & Respiratory Disease 2288-0402 2288-0410 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 10.4168/aard.2016.4.3.212 Case Report Rapid desensitization to isoniazid and rifampin in an adolescent with active pulmonary tuberculosis Lee Heirim Kim Min-Sun Yang Hea-Kyoung Kim Minji Lee Ji Young Kim Jong-Min * Kang Ji-Man Kim Yae-Jean Ahn Kangmo http://orcid.org/0000-0001-8493-2881 Kim Jihyun Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Correspondence to: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-1035, Fax: +82-2-3410-0805, jhlovechild@gmail.com

*Current address: Department of Pediatrics, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea.

 05 2016 31 05 2016 4 3 212 216 25 07 2015 02 10 2015 06 10 2015 © 2016 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Hypersensitivity reactions to antituberculosis medicine are obstacles to the treatment of tuberculosis. However, rapid drug desensitization can secure successful treatment with essential antituberculosis medicines in pediatric patients. A 17-year-old boy with active pulmonary tuberculosis complained of generalized erythematous rashes, pruritus on the 11th day of tuberculosis treatment. He was diagnosed with hypersensitivity reactions to isoniazid and rifampin by the oral provocation test. After desensitization, the patient continued to take antituberculosis treatment with isoniazid, rifampin, pyrazinamide, and ethambutol. We report here a case of successful desensitization in an adolescent with hypersensitivity to isoniazid and rifampin.

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Prick test Intradermal test
Concentration (mg/mL) 15 min (mm) Concentration (mg/mL) 15 min (mm) 24 hr (mm) 72 hr (mm)
Histamine 10 5×5 - - - -
0.9% Saline - 0×0 - 0×0 0×0 0×0
Rifampin 0.002 0×0 0.002 0×0 0×0 0×0
0.02 0×0 0.02 0×0 0×0 0×0
0.2 0×0 0.2 5×5 0×0 0×0
2 0×0 2 5×5 0×0 0×0
Isoniazid 0.002 0×0 0.002 0×0 0×0 0×0
0.02 0×0 0.02 0×0 0×0 0×0
0.2 0×0 0.2 5×5 0×0 0×0
2 0×0 2 5×5 0×0 0×0
Oral desensitization protocol for rifampin
Step Time (min) Administered dose (mg) Cumulative dose (mg)
1 0 0.0002 0.0002
2 30 0.002 0.002
3 60 0.02 0.02
4 90 0.2 0.2
5 120 2 2.2
6 150 4 6.2
7 180 8 14.2
8 210 16 30.2
9 240 30 60.2
10 270 50 110.2
11 300 100 210.2
12 330 150 360.2
13 360 250 610.2
Oral desensitization protocol for isoniazid
Step Time (min) Administered dose (mg) Cumulative dose (mg)
1 30 0.1 0.1
2 60 0.5 0.6
3 90 1 1.6
4 120 2 3.6
5 150 4 7.6
6 180 8 15.6
7 210 16 31.6
8 240 32 63.6
9 270 50 113.6
10 300 100 213.6
11 330 100 313.6