Successful desensitization for antitubercular drugs

Ae-Ra Lee; Soo Jung Kim; Junghyun Kim; Ju-Hee Park; Jung-Kyu Lee; Ju-Young Kim; Suh-Young Lee; Hye-Ryun Kang

doi:10.4168/aard.2013.1.4.395

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Lee, Kim, Kim, Park, Lee, Kim, Lee, and Kang: Successful desensitization for antitubercular drugs

Case Report

Allergy, Asthma & Respiratory Disease 2013; 1(4): 395-399.

Published online: 31 December 2013

DOI: https://doi.org/10.4168/aard.2013.1.4.395

Successful desensitization for antitubercular drugs

Ae-Ra Lee¹, Soo Jung Kim¹, Junghyun Kim¹, Ju-Hee Park¹, Jung-Kyu Lee¹, Ju-Young Kim^1,², Suh-Young Lee^1,^2,³, Hye-Ryun Kang^1,^2,³

¹Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

²Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

³Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea.

Correspondence to: Hye-Ryun Kang. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-0820, Fax: +82-2-742-3291, helenmed@snu.ac.kr

Received 10 July 2013 Revised 16 July 2013 Accepted 23 July 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Tuberculosis is an infectious disease that can be treated using a combination of antitubercular drugs. First-line antitubercular agents such as isoniazid and rifampin are considered pivotal to successful treatment. However, they are also known to have relatively high rates of adverse events including hypersensitivity reactions. Discontinuing the first-line agents in the event of hypersensitivity may significantly compromise the cure rate of tuberculosis. Drug desensitization can be an effective method allowing continued use of the first-line agents and achieving successful cure of tuberculosis. A 70-year-old man was diagnosed with culture proven pulmonary tuberculosis and treated with first-line antitubercular agents (isoniazid, 300 mg; rifampin, 600 mg; pyrazinamide, 1,500 mg; and ethambutol, 800 mg). After 2 weeks of treatment, generalized erythematous papular rash and fever developed, for which all drugs were discontinued. Since he had hypersensitivity to all 4 first-line antitubercular agents, we tried desensitization for all 4 drugs one by one to resume antituberculosis treatment. After successful desensitization of all 4 first-line antituberculosis drugs, 6 months-antitubercular therapy was completed without any complications. We report here a case of multiple desensitization in a pulmonary tuberculosis patient having hypersensitivity to all of the 4 first-line antitubercular drugs, successfully completing 6-month antitubercular therapy without any complications.

Keywords: Drug hypersensitivity, Antitubercular agents, Desensitization, Tuberculosis

Figures and Tables

Table 1

Drugs related with hypersensitivity reactions

Table 2

Oral desensitization protocol for isoniazid (target dose: 300 mg)

Solution for step 1-6: isoniazid 10 mg+dextrose 5% in water 50 mL (0.2 mg/mL); solution for step 7-11: isoniazid 100 mg+dextrose 5% in water 50 mL (2 mg/mL).

Table 3

Oral desensitization protocol for rifampin (target dose: 600 mg)

Solution for step 1-6: rifampin 150 mg+dextrose 5% in water 500 mL (0.3 mg/mL); solution for step 7-12: rifampin 150 mg+dextrose 5% in water 50 mL (3 mg/mL).

Table 4

Oral desensitization protocol for ethambutol (target dose: 800 mg)

Solution for step 1-6: ethambutol 40 mg+dextrose 5% in water 40 mL (1 mg/mL); solution for step 7-10: ethambutol 400 mg+dextrose 5% in water 40 mL (10 mg/mL).

Table 5

Oral desensitization protocol for pyrazinamide (target dose: 1,500 mg)

Solution for step 1-6: pyrazinamide 60 mg+dextrose 5% in water 20 mL (3 mg/mL); solution for step 7-10: pyrazinamide 1500 mg+dextrose 5% in water 50 mL (30 mg/mL).

Notes

This research was supported by a grant from Ministry of Food and Drug Safety to operation of the regional pharmacovigilance center in 2013.

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