Hyposensitization trial using salazosulfapyridine in a case of mesalamine intolerance

Area of Science:

• Gastroenterology
• Clinical Pharmacology

Background:

• Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
• Mesalamine is a common first-line treatment for mild to moderate UC.
• Switching to alternative therapies is necessary when mesalamine is ineffective or not tolerated.

Observation:

• A 47-year-old male diagnosed with pancolitis-type UC developed fever and abdominal pain, attributed to mesalamine side effects.
• The patient exhibited allergic symptoms upon mesalamine hyposensitization and after ingesting an oral sodium phosphate solution.
• Symptoms included abdominal pain and myalgia, indicating mesalamine intolerance.

Findings:

• Hyposensitization therapy with mesalamine (unmodified and time-dependent release forms) was attempted.
• Despite hyposensitization, allergic reactions persisted, necessitating a treatment change.
• Successful introduction and titration of salazosulfapyridine (SASP) to 2000 mg/day resolved the patient's symptoms.

Implications:

• This case highlights a rare instance of mesalamine intolerance requiring a switch to salazosulfapyridine.
• It demonstrates the feasibility of hyposensitization for mesalamine-induced hypersensitivity.
• The findings underscore the importance of considering alternative therapeutic strategies in refractory UC cases.