Ultra-rapid desensitization with rifampicin syrup

Abstract

Hypersensitivity (HS) reactions to antituberculosis drugs are difficult to manage, notably since the advent of multiresistant tuberculosis. In patients with immediate HS to antituberculosis drugs, a rapid desensitization(DS) procedure may represent an interesting alternative. Study objectivesDescribe the procedure for rapid oral DS with rifampicin syrup/suspension and demonstrate its contribution to the management of tuberculosis (TB). MethodsA cross sectional study including patients followed-up for tuberculosis in pulmonology C department of Abderrahman Mami Ariana hospital between 2003–2020. Patients with confirmed immediate HS were desensitized with a suspension of Rifampicin (100mg/5ml). Informed consent of patients or guardian was required. ResultsUltrarapid DS with rifampicin syrup/suspensionwas performed in 14 patients (8 men, 6 women, mean age 32±12.5 years). The mean times between initiation of the treatment, the last administration of the drug and onset ofthe reactions were 16.5 days (range:3–47 days) and 204minutes (20–420min)respectively. Most reactions were urticaria, pruritus and erythema. Severe anaphylaxis was reported in 2 cases and Quincke edema in 1 case. Nine patients (64.3%) were successfully desensitized. In 5 patients (35.7%), ultrarapid desensitization failed. ConclusionReactions to rifampicin are diverse and unpredictable. The severity of the allergic reaction and the absence of other effective therapeutic alternatives are arguments in favor of drug desensitization. Despite the diversity of protocols reported in the literature, the results of desensitization are generally favorable, with a significant success rate.