Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Immediate Hypersensitivity to Rifampicin in 3 Patients: Diagnostic Procedures and Induction of Clinical Tolerance

Buergin S.a · Scherer K.b · Häusermann P.b · Bircher A.J.b

Author affiliations

aDepartment of Rheumatology, and bAllergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland

Related Articles for ""

Int Arch Allergy Immunol 2006;140:20–26

Do you have an account?

Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: October 05, 2005
Accepted: December 19, 2005
Published online: April 13, 2006
Issue release date: April 2006

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 2

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: https://www.karger.com/IAA

Abstract

Background: Desensitization with drugs may be indicated in some clinical situations. Apart from large experiences with β-lactam antibiotics and cotrimoxazole in HIV infection, experience with other drugs is limited. Rifampicin may elicit exanthema and urticaria, and their pathomechanisms are not known in detail. Since therapy with rifampicin may be indispensable in mycobacterial infections or against multiresistant Staphylococcusaureus, desensitization may be indicated in some patients. Objective: Report of immediate hypersensitivity to rifampicin and description of diagnostic and desensitization procedures. Methods: We report 3 patients with immediate urticarial reactions to rifampicin. Diagnostic procedures included skin and in vitro tests (specific IgE, lymphocyte transformation test, LTT, and CAST®). The non-irritant cutoff concentration was evaluated in 24 volunteers. A 7-day desensitization procedure was used. Results: Only intradermal tests at a dilution of at least 1:10,000 (concentration of rifampicin approximately 0.006 mg/ml) were true positive, whereas in vitro tests (IgE, LTT and CAST) did not correctly identify hypersensitive patients. Two patients had positive accidental reexposure. All patients were successfully desensitized with rifampicin according to a slow 7-day protocol. Conclusions: Rifampicin rarely elicits immediate hypersensitivity symptoms which may be diagnosed by intradermal skin tests. In vitro tests did not contribute to the diagnosis. Therefore, an IgE-mediated mechanism remains to be proven. Desensitization with rifampicin using different protocols has been reported. In our 3 cases, clinical tolerance to rifampicin was achieved using a 7-day protocol.

© 2006 S. Karger AG, Basel


References

  1. Greenberger P: Desensitization and test-dosing for the drug-allergic patient. Ann Allergy Asthma Immunol 2000;85:250–251.
  2. Beall G, Sanwo M, Hussain H: Drug reactions and desensitization in AIDS. Immunol Allergy Clin North Am 1997;17:319–338.
    External Resources
  3. Greenberger PA: Drug challenge and desensitization protocols. Immunol Allergy Clin North Am 1998;18:759–772.
    External Resources
  4. Naclerio R, Mizrahi EA, Adkinson NF: Immunologic observations during desensitization and maintenance of clinical tolerance to penicillins. J Allergy Clin Immunol 1983;71:294–301.
  5. Bircher AJ: Desensibilisierung bei İberempfindlichkeitsreaktionen auf Arzneimittel. Allergologie 1997;20:412–422.
    External Resources
  6. Kim JH, Kim HB, Kim BS: Rapid oral desensitization to isoniazid, rifampicin and ethambutol. Allergy 2003;58:540–541.
  7. Acocella G: Pharmacokinetics and metabolism of rifampin in humans. Rev Infect Dis 1983;5:S428–S432.
  8. Widmer AF, Gaechter A, Ochsner PE, Zimmerli W: Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations. Clin Infect Dis 1992;14:1251–1253.
  9. Bircher AJ, Figueiredo V, Scherer K, Surber C: Accuracy of serial dilution concentrations for intradermal skin testing: a neglectable problem? Contact Dermatitis 2004;50:186–187.
    External Resources
  10. Manfredi M, Severino M, Testi S, Macchia D, Ermini G, Pichler WJ, Campi P: Detection of specific IgE to quinolones. J Allergy Clin Immunol 2004;113:155–160.
  11. Schaub N, Bircher AJ: Severe hypersensitivity syndrome to lamotrigine confirmed by lymphocyte stimulation in vitro. Allergy 2000;55:191–193.
  12. Sanz ML, Maselli JP, Gamboa PM, Oehling A, Dieguez I, de Weck AL: Flow cytometric basophil activation test: a review. J Investig Allergol Clin Immunol 2002;12:143–154.
  13. Bircher AJ, Scherer K, Grize L, Schindler C: Non-irritant threshold concentrations for intradermal skin tests with rifampicin, ciprofloxacin, and clarithromycin. Allergy Clin Immunol Int 2005;suppl 1:57.
  14. Abong JM, Andutan MMC: Antituberculous drug desensitization. J Allergy Clin Immunol 1999;103:S34.
  15. Alonso MD, De La Hoz B, Cuevas M, Beick A: Desensibilización a rifampicina. A propósito de un caso. Med Clin 1996;106:319.
  16. Holland CL, Malasky C, Ogunkoya A, Bielory L: Rapid oral desensitization to isoniazid and rifampin. Chest 1990;98:1518–1519.
  17. Matz J, Borish LC, Routes JM, Rosenwasser LJ: Oral desensitization to rifampin and ethambutol in mycobacterial disease. Am J Respir Crit Care Med 1994;149:815–817.
  18. Pech O, May A, Henrich R, Mayer G: Schnelldesensibilisierung mit Rifampicin. Dtsch Med Wochenschr 2001;126:16.
  19. Parra FM, Pérez Elias MJ, Cuevas M, Ferreira A: Serum sickness-like illness associated with rifampicin. Ann Allergy 1994;73:123–125.
  20. Trautmann A, Bröcker EB, Klein CE: Haut reaktionen bei antituberkulöser Chemotherapie. Allergologie 1995;18:138–144.
    External Resources
  21. Girling DJ, Hitze KL: Adverse reactions to rifampicin. Bull World Health Organ 1979;57:45–49.
  22. O’Mahony MG, Kar CW: Relationship between rifampicin-dependent antibody scores, serum rifampicin concentrations and symptoms in patients with adverse reactions to intermittent rifampicin treatment. Clin Allergy 1973;3:353–362.
  23. Ohta K, Labovitz E, Harbeck RJ, Takizawa H, Ishii A, Miyamoto T: Development of RAST for detecting anti-rifampicin IgE antibodies. J Allergy Clin Immunol 1987;79:221.
    External Resources
  24. Grosset J, Leventis S: Adverse effects of rifampin. Rev Infect Dis 1983;5(suppl 3):S440–S450.
  25. Holdiness MR: Adverse cutaneous reactions to antituberculosis drugs. Int J Dermatol 1985;24:280–285.
  26. Aquinas M, Allan WG, Horsfall PA, Jenkins PK, Hung-Yan W, Girling D, et al: Adverse reactions to daily and intermittent rifampicin regimens for pulmonary tuberculosis in Hong Kong. Br Med J 1972;i:765–771.
  27. Canova CR, Kuhn M, Zellweger U, Reinhardt WH: Fulminante, rasch reversible Hepatitis und lebensgefährliche Anaphylaxie nach Rifampicin bei einer HIV-positiven Patientin mit latenter Nebennierenrinden-Insuffizienz. Schweiz Med Wochenschr 1996;126:392–397.
  28. Cnudde F, Leynadier F: The diagnosis of allergy to rifampicin confirmed by skin test. Am J Med 1994;97:403–404.
  29. Harland RW, Lindblom SS, Munnell MO: Anaphylaxis from rifampin. Am J Med 1992;92:581–582.
  30. Leynadier F, Dehee D, Mellin B, Dry J: Le choc anaphylactique à la rifampicin. Entité rare mais grave. Paris, Entretiens de Bichat Pitié-Salpétrière Médecine, 1988.
  31. Alvarez Cuesta E, Hernández-Peña J, Blanco R, Gozalo F, Cuesta J: Oral desensitization with antituberculosis drugs. J Allergy Clin Immunol 1997;99:S431.
  32. Driria I, Souissi R, Dakhlaoui R, Jequirim MS, Chebbi ML: Désensibilisation orale aux anti-tuberculeux. Rev Pneumol Clin 1997;53:104–106.
    External Resources
  33. Dutau H, Saadjian M, Bonneau V, Charpin D: Unsuccessful rapid intravenous desensitization to rifampicin. Allergy 2000;55:778–779.
  34. Solensky R: Drug desensitization (review). Immunol Allergy Clin North Am 2004;24:425–443.
  35. Borish L, Tamir R, Rosenwasser LJ: Intravenous desensitization to beta-lactam antibiotics. J Allergy Clin Immunol 1987;80:314–319.
  36. Sullivan TJ: Antigen-specific desensitization of patients allergic to penicillins. J Allergy Clin Immunol 1982;69:500–508.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: October 05, 2005
Accepted: December 19, 2005
Published online: April 13, 2006
Issue release date: April 2006

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 2

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: https://www.karger.com/IAA


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.