抗结核药物相关性嗜酸粒细胞增多和全身症状患者中抗结核药物的再引入。

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

机构信息

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.

Department of Immunology and Rheumatology, Nepean Hospital, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

出版信息

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

DOI:10.1016/j.jaip.2021.03.054

PMID:33872812

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.

摘要

背景

结核病（TB）治疗期间发生药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）的患者通常会出现多种药物过敏反应，导致抗 TB 药物选择有限。因此，根据脱敏方案重新引入可能是恢复抗 TB 药物治疗的一种选择。

目的

评估根据重新引入方法在抗 TB 药物相关 DRESS 患者中恢复使用抗 TB 药物的结果和安全性。

方法

从 5 个不同的机构中建立了一个回顾性队列，其中包括 2011 年至 2017 年期间经历过抗 TB 药物相关严重皮肤不良反应的患者。

结果

29 例抗 TB 药物相关 DRESS 患者中有 27 例通过完全改变方案（n=9）、分级挑战重新引入（n=5）或脱敏方案重新引入（n=13）恢复了抗 TB 治疗。9 例患者完全改变了他们的抗 TB 方案，改用二线 TB 药物，但只有 1 例（11.1%）成功维持了新的抗 TB 药物。其他 8 例由于对新引入的抗 TB 药物发生过敏反应而无法服用药物。5 例接受分级再挑战的患者中，有 2 例（40.0%）成功完成了抗 TB 药物治疗，而另外 3 例（60%）由于过敏反应复发而无法恢复抗 TB 药物治疗。在 13 例使用脱敏方案重新引入抗 TB 药物的患者中，没有一人发生 DRESS 复发；11 例（84.6%）最终完成了抗 TB 治疗，2 例最终因迟发性瘙痒和药物性肝损伤而无法完成抗 TB 治疗。