Drug-Induced Hypersensitivity Reaction and Re-Introduction of Anti-Tubercular Drugs (ATT): A Case Report and Review of Literature
Abstract
Tuberculosis (TB) is a communicable disease caused by the bacillus Mycobacterium tuberculosis and is the leading cause of death by a single infectious agent overall. According to the WHO Global TB Report, India contributes to 26% of the global burden of TB. Currently, a four-drug regimen comprising Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol is approved for the treatment of drug-sensitive TB. The management of cutaneous adverse drug reactions to anti-tubercular drugs is akin to a double-edged sword, with discontinuation of ATT increasing the risk of developing disseminated and drug-resistant tuberculosis, and continuation leading to persistence or exacerbation of the adverse drug reaction (ADR). The risk of developing an ADR to anti-tubercular therapy (ATT) varies from 8 to 85% in various studies [10]. The prevalence of rashes associated with ATT shows that the maculopapular rash (42.5%) is the most frequently observed type, followed by urticarial, lichenoid, DRESS, AGEP, and exfoliative dermatitis (17). The drugs associated with Cutaneous ADRs from the lowest to the highest risk are Isoniazid, Rifampicin, Pyrazinamide, Ethionamide, Cycloserine, Ethambutol, Para-aminosalicylic acid (PAS), and Streptomycin (25). We present a case and approach to the re-introduction of first-line anti-tubercular drugs after hypersensitivity with fixed-dose combinations.
Keywords: Tuberculosis, Mycobacterium tuberculosis, adverse drug reaction, anti-tubercular therapy
Keywords:
Tuberculosis, Mycobacterium tuberculosis, adverse drug reaction, anti-tubercular therapyDOI
https://doi.org/10.22270/jddt.v13i6.6080References
Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004; 113(5):832–6. https://doi.org/10.1016/j.jaci.2003.12.591 PMID: 15131563.
Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, et al. International Consensus on Drug Allergy. Allergy. 2014; 69(4):420–37. https://doi.org/10.1111/all.12350 PMID: 24697291.
Mirakian R, Ewan PW, Durham SR, Youlten LJ, Dugue P, Friedmann PS, et al. BSACI guidelines for the management of drug allergy. Clin Exp Allergy. 2009; 39(1):43–61. https://doi.org/10.1111/j.1365- 2222.2008.03155.x PMID: 19128352.
Rezakovic S, Pastar Z, Kostovic K. Cutaneous adverse drug reactions caused by antituberculosis drugs. Inflamm Allergy Drug Targets. 2014; 13(4):241–8. https://doi.org/10.2174/1871528113666140717113358 PMID: 25039910.
Chang KC, Leung CC, Tam CM. Risk factors for defaulting from anti-tuberculosis treatment under directly observed treatment in Hong Kong. Int J Tuberc Lung Dis. 2004; 8(12):1492–8. PMID: 15636497.
Chhetri AK, Saha A, Verma SC, Palaian S, Mishra P, Shankar PR. Study of adverse drug reactions caused by first-line anti-tubercular drugs used in directly observed treatment, short course (DOTS) therapy in Western Nepal, Pokhara. J Pak Med Assoc. 2008; 58(10):531–6. PMID: 18998303.
Lv X, Tang S, Xia Y, Wang X, Yuan Y, Hu D, et al. Adverse reactions due to directly observed treatment strategy therapy in Chinese tuberculosis patients: a prospective study. PLoS One. 2013; 8(6):e65037. https://doi.org/10.1371/journal.pone.0065037 PMID: 23750225; PubMed Central PMCID: PMC3672195.
Dela AI, Tank NKD, Singh AP, Piparva KG. Adverse drug reactions and treatment outcome analysis of DOTS-plus therapy of MDR-TB patients at district tuberculosis center: A four-year retrospective study. Lung India. 2017; 34(6):522–6. https://doi.org/10.4103/0970-2113.217569 PMID: 29098997; PubMed Central PMCID: PMC5684809.
Pichler WJ, Srinoulprasert Y, Yun J, Hausmann O. Multiple Drug Hypersensitivity. Int Arch Allergy Immunol. 2017; 172(3):129–38. https://doi.org/10.1159/000458725 PMID: 28315874; PubMed Central PMCID: PMC5472211.
Shin H-J, Chang J-S, Kim M-S, Koh B-G, Park H-Y, Kim T-O, et al. Hypersensitivity reactions to multiple anti-tuberculosis drugs. PLoS ONE 2021; 16(2):e0246291. https://doi.org/10.1371/journal. pone.0246291
Kim SH, Kim SH, Yoon HJ, et al. GSTT1 and GSTM1 null mutations and adverse reactions induced by antituberculosis drugs in Koreans. Tuberculosis (Edinb). 2010; 90(1):39–43. https://doi.org/10.1016/j.tube.2009.12.001
Kim SH, Kim SH, Yoon HJ, et al. CTP2C9, CYP2C19, and CYP2E1 genetic polymorphisms in anti-TB drug-induced maculopapular eruption. Eur J Clin Pharmacol. 2011; 67(2):121–127. https://doi.org/10.1007/s00228-010-0912-4
SH Kim, YK Jee, JH Lee, et al. ABCC2 haplotype is associated with antituberculosis drug-induced maculopapular eruption. Allergy Asthma Immunol Res. 2011; 4(6):362–366. https://doi.org/10.4168/aair.2012.4.6.362
Tan WC, Ong CK, Kang SC, Razak MA. Two years review of cutaneous adverse drug reaction from first-line antituberculous drugs. Med J Malaysia 2007; 62:143 6.
Resende LS, Santos Neto ET. Risk factors associated with adverse reactions to antituberculosis drugs. J Bras Pneumol 2015; 41:77 89. https://doi.org/10.1590/S1806-37132015000100010
Hernández Salazar A, Rosales SP, Rangel Frausto S, Criollo E, Archer Dubon C, Orozco Topete R, et al. Epidemiology of adverse cutaneous drug reactions. A prospective study in hospitalized patients. Arch Med Res 2006; 37:899 902 https://doi.org/10.1016/j.arcmed.2006.03.010
Sharma RK, Verma GK, Tegta GR, Sood S, Rattan R, Gupta M. Spectrum of cutaneous adverse drug reactions to antitubercular drugs and safe therapy after rechallenge - A retrospective study. Indian Dermatol Online J 2020; 11:177-81. https://doi.org/10.4103/idoj.IDOJ_133_19
Alomar MJ. Factors affecting the development of adverse drug reactions. Saudi Pharm J 2014; 22:83 94. https://doi.org/10.1016/j.jsps.2013.02.003
Yew WW, Chan DP, Leung CC, Zhang Y, Wang R, Ng P, et al. Can toxicities induced by antituberculosis drugs be better managed in diabetic patients? Eur Respir J 2017; 50:1700409. https://doi.org/10.1183/13993003.00409-2017
Castro AT, Mendes M, Freitas S, Roxo PC. Incidence and risk factors of major toxicity associated with first-line antituberculosis drugs for latent and active tuberculosis during a period of 10 years. Rev Port Pneumol 2015; 21:144 50. https://doi.org/10.1016/j.rppnen.2014.08.004
Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D. Incidence of serious side effects from 1st line anti-tuberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med 2003; 167:1472 7. https://doi.org/10.1164/rccm.200206-626OC
Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: General considerations. Allergy 2003; 58:854 63. https://doi.org/10.1034/j.1398-9995.2003.00279.x
Kakande B, Lehlohnya RJ. Drug reactions associated with anti-tubercular drugs. Curr Allergy Clin Immunol 2015; 28:264 7.
Medicines Information Center University of Cape Town. Management of Suspected Drug-Induced Rash, Kidney Injury and Liver Injury in Adult Patients on TB Treatment and/or Antiretroviral Treatment. 2018.
Abe R. Immunological Response in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. J Dermatol 2015; 42:42–48 https://doi.org/10.1111/1346-8138.12674
World Health Organization. Treatment of Tuberculosis Guidelines. 2010. Epub ahead of print 2010. DOI: https://doi.org/10.1007/s10405-019-0234-x .
Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis an Off Publ Infect Dis Soc Am 2016; 63:e147– e195. https://doi.org/10.1093/cid/ciw376
Nur Prasetyo et al Allergic Reaction due to Anti-Tuberculosis Drugs, How to manage?, Jurnal Respirasi, May 2021; 07(02):79-85. https://doi.org/10.20473/jr.v7-I.2.2021.79-85
Published
Abstract Display: 1495 
PDF Downloads: 4734 PDF Downloads: 99 How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
How to Cite
.