Asthma Allergy Immunology

Asthma Allergy Immunology

2024, Vol 22, Num, 2     (Pages: 181-188)

Non-Immediate Type Hypersensitivity Reactions with First-Line Antituberculosis Drugs and Diagnostic Patch Testing

Gozde KOYCU BUHARI 1, Sakine NAZIK BAHCECIOGLU 1, Selcan GULTUNA 1, Dilek CUHADAR ERCELEBI 1, Senay DEMIR 1, Hatice CELIK TUGLU 1, Onur TELLI 1, Kurtulus AKSU 1,

1 Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Türkiye

DOI: 10.21911/aai.2024.601
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Objective: To evaluate the characteristics of non-immediate type hypersensitivity reactions with first-line antituberculosis drugs and determine the causative drugs by patch tests and drug provocation tests.

Materials and Methods: Baseline data including patients` demographics, disease characteristics, and drug hypersensitivity reaction characteristics were recorded. Patch testing was performed with all the drugs used during hypersensitivity reaction at 1/10 and 1/1 concentrations. Drug provocation tests were performed at 3-day intervals with drugs that had negative patch test results.

Results: A total of 32 patients were included in the study. The clinical phenotype was maculopapular eruption in 11(34.4%), dermatitis in 10 (31.3%), drug reaction with eosinophilia and systemic symptoms in 1 (3.1%), and Stevens-Johnson syndrome/Toxic epidermal necrolysis in 10 (31.3%) patients. Combination therapy during the index reaction consisted of isoniazid (H), rifampicin (R), pyrazinamide (Z), and ethambutol (E) in 28 (87.5%) patients, Patch tests were performed with 95 drugs consisting of 25 H, 25 R, 21 Z, and 24 E in 25 patients. Results were positive in 8 patients with 10 drugs: 8 (32%) H, 1 (4%) R, and 1 (4.2%) E positivity were detected. Drug provocation tests were performed with 78 drugs (18 H, 23 R, 15 Z, 22 E) in 25 patients and resulted positive with H, R, Z, and E in 16.7% (3 of 18), 21.7% (5 of 23), 46.7% (7 of 15), and 54.5% (12 of 22) of the patients respectively. Negative predictive values of patch tests with H, R, Z, and E were calculated as 87.5% (14/16), 81.8% (18/22), 50% (7/14), and 45% (9/20) respectively. According to the results of the patch tests and provocation tests, the most common culprit of hypersensitivity reactions was found to be E (n=12), followed by H (n=10). Multiple drug hypersensitivity was detected in 9 of 23 (39.1%) patients.

Conclusion: Patch testing is useful in the management of non-immediate type hypersensitivity with first-line antituberculosis drugs. However, further studies are needed to determine its predictive value

Keywords : Non-immediate, hypersensitivity, antituberculosis, patch test, drug provocation