Successful Sequential and Additive Drug Challenge With Rapid Oral Desensitization in Rifampicin-Induced Fever

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Adverse drug reactions to first-line antituberculosis (anti-TB) therapy are common, often leading to treatment interruption.
• Drug desensitization is established for severe hypersensitivity, but evidence for outpatient rapid oral desensitization in mild reactions like drug-induced fever is limited.

Purpose of the Study:

• To evaluate the feasibility and efficacy of outpatient rapid oral desensitization for drug-induced fever in a patient undergoing anti-TB therapy.
• To demonstrate a potential strategy for managing mild delayed hypersensitivity reactions to anti-TB medications.

Main Methods:

• A 63-year-old male with pulmonary tuberculosis developed drug-induced fever from anti-TB therapy.
• Sequential and additive drug challenge identified rifampicin as the cause.
• The patient underwent successful outpatient rapid oral rifampicin desensitization.

Main Results:

• The patient completed the full 6-month anti-TB therapy without recurrence of fever or adverse effects.
• Outpatient rapid oral desensitization proved feasible for managing rifampicin-induced fever.
• This intervention allowed for uninterrupted treatment completion.

Conclusions:

• Outpatient rapid oral desensitization is a viable option for mild delayed hypersensitivity reactions, such as drug-induced fever, to anti-TB drugs.
• This approach may decrease treatment interruptions and hospitalizations, especially where standardized protocols are absent.
• Further research is required to establish optimal strategies for managing mild delayed hypersensitivity reactions to anti-TB medications.