Mesalazine allergy and an attempt at desensitization therapy in patients with inflammatory bowel disease

Satohiro Matsumoto,Hirosato Mashima

doi:10.1038/s41598-020-79207-z

Abstract

Mesalazine is a key drug used for remission induction and maintenance therapy in inflammatory bowel disease (IBD). We sometimes encounter patients who develop allergic reactions to the drug and inevitably discontinue treatment. Of 692 patients who received mesalazine for IBD between 2014 and March 2020, 33 diagnosed with mesalazine allergy (43 episodes) were included, and their clinical manifestations were evaluated. For ten patients undergoing desensitization therapy, therapeutic outcomes were evaluated. The incidence of mesalazine allergy was 4.8%. The time from the start of oral medication to allergy onset was 10 ± 5 days for the first allergic attack and 2 ± 1 days for the second and subsequent allergic attacks. The observed clinical symptoms included fever (93%), diarrhea (26%), abdominal pain (23%), and bloody stool (12%). Drug-induced lymphocyte stimulation test was performed in 85% of the patients (28/33), and the sensitivity was 51%. Desensitization therapy with a time-dependent mesalazine granule formulation was successful in nine of the ten patients (90%), allowing them to receive 2000 mg or more of the drug. Fever was a common allergic symptom, and its presence appeared to be useful for distinguishing mesalazine allergy from exacerbation of the primary disease. Desensitization therapy was useful in patients with mesalazine allergy.

Highlights

Mesalazine is a key drug used for remission induction and maintenance therapy in inflammatory bowel disease (IBD)
No significant differences were observed between the allergy and non-allergy groups in sex, disease type, age at onset, each disease location, or type of mesalazine
C-reactive protein (CRP) level at the start of treatment was 1.8 ± 2.8 mg/dL in the allergy group and 1.2 ± 2.5 mg/dL in the non-allergy group, with no significant differences between the two groups

Summary

Introduction

Mesalazine is a key drug used for remission induction and maintenance therapy in inflammatory bowel disease (IBD). Fever was a common allergic symptom, and its presence appeared to be useful for distinguishing mesalazine allergy from exacerbation of the primary disease. Adverse reactions to mesalazine are observed in 15.8% of patients with ulcerative colitis Of these patients, 4.6% present with diarrhea and 1.4% present with bloody stool or fever[1]. Our previous report showed that 5.5% of patients with ulcerative colitis developed adverse reactions to pH-dependent mesalazine formulations[3]. Drug allergy is an immunologically mediated reaction to pharmacologically active agents or inactive ingredients. It occurs after the sensitization phase, and its development is associated with drug-specific antibodies, sensitized T cells, or both[4]. We examined patients who developed mesalazine allergy, and desensitization therapy was attempted in some of them

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Results

Conclusion