Kung Shiang-Ju, Choudhary Cuckoo, McGeady Stephen J, Cohn John R
Division of Allergy and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Ann Allergy Asthma Immunol. 2006 Sep;97(3):284-7. doi: 10.1016/S1081-1206(10)60790-9.
5-Aminosalicylic acid (5-ASA)-containing drugs are the mainstay of therapy in inflammatory bowel disease, but adverse reactions to these medications are relatively common. Because there may be a lack of cross-reactivity among the various 5-ASA formulations, treatment with alternative preparations is sometimes possible even after an apparent allergic reaction to a 5-ASA product.
To describe a patient with a possible allergy to 2 different 5-ASA drugs who tolerated a third.
A 27-year-old man with Crohn disease developed a rash while taking mesalamine (Pentasa and Asacol). Treatment with 5-ASA products was discontinued, and 6-mercaptopurine and prednisone were prescribed. He then experienced multiorgan failure secondary to herpes simplex infection, which required discontinuation of the immunosuppressive therapy. After recovery from the acute infection, he underwent successful graded challenge with balsalazide.
The patient continued treatment with balsalazide for 9 months, with good control of his inflammatory bowel disease and no adverse effects.
Adverse reactions to 1 or more 5-ASA medications do not necessarily preclude the use of others in the same class. A treatment algorithm for patients with adverse reactions to 5-ASA is outlined based on the case report and review of the literature.
含5-氨基水杨酸（5-ASA）的药物是炎症性肠病治疗的主要药物，但这些药物的不良反应相对常见。由于不同的5-ASA制剂之间可能缺乏交叉反应性，因此即使在对某种5-ASA产品出现明显过敏反应后，有时也可以使用其他制剂进行治疗。
描述一名对两种不同的5-ASA药物可能过敏，但能耐受第三种药物的患者。
一名27岁的克罗恩病男性在服用美沙拉嗪（颇得斯安和艾迪莎）时出现皮疹。停用5-ASA产品治疗，并开具了6-巯基嘌呤和泼尼松。随后，他因单纯疱疹感染继发多器官功能衰竭，需要停用免疫抑制治疗。从急性感染中恢复后，他成功地接受了巴柳氮分级激发试验。
患者继续使用巴柳氮治疗9个月，炎症性肠病得到良好控制，且无不良反应。
对一种或多种5-ASA药物的不良反应不一定排除使用同一类中的其他药物。根据该病例报告和文献综述，概述了5-ASA不良反应患者的治疗方案。
