Journal List > Allergy Asthma Respir Dis > v.4(3) > 1059181

Lee, Kim, Yang, Kim, Lee, Kim, Kang, Kim, Ahn, and Kim: Rapid desensitization to isoniazid and rifampin in an adolescent with active pulmonary tuberculosis

Abstract

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.

Figures and Tables

Table 1

The result of skin test of rifampin and isoniazid

aard-4-212-i001
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
Table 2

Oral desensitization protocol for rifampin

aard-4-212-i002
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
Table 3

Oral desensitization protocol for isoniazid

aard-4-212-i003
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

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Jihyun Kim
https://orcid.org/http://orcid.org/0000-0001-8493-2881

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