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Ulcerative colitis patients with an inflammatory response upon mesalazine cannot be desensitized: a randomized study.
Dorien J Buurman1, Jan G R De Monchy, Reinout C A Schellekens
1Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.
Scandinavian Journal of Gastroenterology
|January 31, 2015
Summary
Mesalazine intolerance in ulcerative colitis (UC) patients often presents as inflammatory reactions. Rapid desensitization is ineffective for these patients, who should not be rechallenged with mesalazine.
Area of Science:
- Gastroenterology
- Clinical Pharmacology
Background:
- Mesalazine is a primary treatment for ulcerative colitis (UC).
- Mesalazine intolerance, characterized by fever and GI symptoms, can occur.
- Previous case reports suggest successful mesalazine desensitization.
Purpose of the Study:
- To determine the rate of persistent mesalazine intolerance in UC patients post-rechallenge.
- To evaluate the efficacy of a rapid desensitization protocol for mesalazine-intolerant UC patients.
Main Methods:
- Prospective, single-blind randomized study of UC patients with prior mesalazine intolerance.
- Exclusion of patients with severe reactions.
- Skin patch testing followed by single-blinded crossover rechallenge with mesalazine or placebo.
- In-hospital 3-day oral desensitization for symptomatic patients.
Main Results:
- Nine UC patients were included; all had negative mesalazine patch tests.
- Seven patients developed symptoms (fever, nausea, vomiting, diarrhea) within 2 hours of rechallenge.
- Four of these seven underwent desensitization, none successfully; all showed inflammatory reactions (elevated C-reactive protein).
- No immediate allergic reactions or elevated markers (serum tryptase, urinary-methylhistamine) were observed.
Conclusions:
- Rechallenging UC patients with mesalazine who exhibit inflammatory responses is not recommended.
- Rapid desensitization protocols are unlikely to benefit UC patients with inflammatory mesalazine intolerance.
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