Reintroduction of Antituberculous Drugs in Patients with Antituberculous Drug-Related Drug Reaction with Eosinophilia and Systemic Symptoms

Ji Hyun Oh; James Yun; Min-Suk Yang; Jung-Hyun Kim; Sae-Hoon Kim; Sujeong Kim; Jeong-Hee Choi; Jae-Joon Yim; Hye-Ryun Kang

doi:10.1016/j.jaip.2021.03.054

Reintroduction of Antituberculous Drugs in Patients with Antituberculous Drug-Related Drug Reaction with Eosinophilia and Systemic Symptoms

J Allergy Clin Immunol Pract. 2021 Sep;9(9):3442-3449.e3. doi: 10.1016/j.jaip.2021.03.054. Epub 2021 Apr 16.

Authors

Ji Hyun Oh¹, James Yun², Min-Suk Yang³, Jung-Hyun Kim⁴, Sae-Hoon Kim⁴, Sujeong Kim⁵, Jeong-Hee Choi⁶, Jae-Joon Yim⁷, Hye-Ryun Kang⁸

Affiliations

¹ Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea; Division of Respiratory-Allergy Medicine, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
² Department of Immunology and Rheumatology, Nepean Hospital, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
⁴ Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
⁵ Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
⁶ Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
⁷ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
⁸ Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea. Electronic address: helenmed@snu.ac.kr.

PMID: 33872812
DOI: 10.1016/j.jaip.2021.03.054

Abstract

Background: Patients who suffered drug reaction with eosinophilia and systemic symptom (DRESS) during the treatment of tuberculosis (TB) commonly experience multidrug hypersensitivity reactions resulting in limited anti-TB drug choices. Therefore, reintroduction based on a desensitization protocol may be an option to resume anti-TB medication.

Objective: To evaluate the outcomes and safety of resuming anti-TB drugs according to reintroduction methods in patients with anti-TB drug-related DRESS.

Methods: A retrospective cohort of patients who had experienced anti-TB drug-related severe cutaneous adverse reactions from 2011 to 2017 was established from separate 5 institutions.

Results: Anti-TB medication was resumed in 27 of 29 patients with anti-TB drug-related DRESS through complete changing regimen (n = 9), reintroduction by a graded challenge (n = 5), or reintroduction using a desensitization protocol (n = 13). Nine patients completely changed their anti-TB regimen to second-line TB drugs, but only 1 (11.1%) succeeded in maintaining new anti-TB drugs. The other 8 failed to take drugs due to the occurrence of hypersensitivity reactions to the newly introduced anti-TB drugs. Two (40.0%) of 5 patients who underwent graded rechallenges successfully completed anti-TB drugs, whereas 3 (60%) failed to resume anti-TB drugs due to the recurrence of hypersensitivity reactions. In 13 patients who resumed anti-TB drugs using a desensitization protocol, no one who underwent desensitization developed recurrence of DRESS; 11 (84.6%) eventually completed anti-TB treatment and 2 eventually failed to complete anti-TB treatment due to late-onset itching and drug-induced liver injury.

Conclusions: Resuming anti-TB medication based on desensitization protocols may be a safe and effective option for those with anti-TB drug-related DRESS.

Keywords: Antitubercular agents; Drug hypersensitivity; Drug hypersensitivity syndrome; Immunologic desensitization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antitubercular Agents / adverse effects
Drug Hypersensitivity Syndrome* / diagnosis
Drug Hypersensitivity Syndrome* / drug therapy
Humans
Pharmaceutical Preparations*
Retrospective Studies
Tuberculosis* / drug therapy

Substances

Antitubercular Agents
Pharmaceutical Preparations