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

BACKGROUND: Data about drug hypersensitivity reactions with first-line antituberculosis drugs and their management is limited.

Rapid drug desensitization seems to be an appropriate management.

OBJECTIVE: Evaluate the efficacy of the rapid desensitization protocols in patients who had a reaction phenotypically compatible with immediate-type drug hypersensitivity with first-line antituberculosis drugs and identify possible risk factors of breakthrough reactions during the protocols.

METHODS: This is a retrospective study of active tuberculosis patients who had a reaction phenotypically compatible with immediate-type drug hypersensitivity with first-line antituberculosis drugs and underwent desensitization with the drugs used during the reaction.

Characteristics of drug hypersensitivity and breakthrough reactions, and outcomes of rapid desensitizations were recorded.

RESULTS: One hundred and seventy-nine patients were included in the study.

Most of the initial reactions (n = 132, 73.7%) occurred within the first week of treatment and were mild (n = 146, 81.6%).

A total of 690 desensitizations were performed.

Desensitizations were successfully completed without any breakthrough reaction in 103 (57.5%) patients and in 29 of 36 (80.6%) patients after a breakthrough reaction.

The overall success of desensitizations were found to be 95% (132 of 139 patients).

Most of the breakthrough reactions (84%) were mild.

Sixteen patients had breakthrough reactions with multiple drugs.

Although pyrazinamide was the most common culprit of breakthrough reactions and had the lowest desensitization success, it had the highest rate of a single breakthrough reaction (p < 0.001).

Timing of the initial reaction and concomitant breakthrough reaction with ethambutol were found to have increased the risk for breakthrough reaction caused by rifampicin (p = 0.017 and p = 0.010 respectively).

CONCLUSION: The rapid desensitization protocols used in this study provide a successful and effective management of the patients with a reaction phenotypically compatible with immediate-type drug hypersensitivity with first-line antituberculosis drugs.