A systematic review of the outcomes of desensitization for delayed-type cutaneous adverse reactions induced by antituberculosis drugs

Abstract

Background: Tuberculosis remains a significant global health concern, affecting millions of people worldwide. Treatment usually involves a combination of drugs; however, drug hypersensitivity reactions pose challenges, particularly due to the diversity of side effects. Cutaneous reactions are common, ranging from maculopapular rash to severe conditions such as drug reaction with eosinophilia and systemic syndrome and Stevens–Johnson syndrome/toxic epidermal necrolysis syndrome. Rechallenge with the same drugs is often practiced, but desensitization has emerged as an alternative in the mitigation of reactions, especially in an outpatient setting. Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched PubMed, EMBASE, Cochrane Library, and CINAHL databases. Studies were included if they involved patients with tuberculosis receiving rechallenge or desensitization, reported postdesensitization outcomes, and were published in English. Data extraction and analysis were independently performed by 2 reviewers. Results: The literature search identified 4,560 potentially eligible articles, of which 7 studies comprising 102 patients met the inclusion criteria. Desensitization success rates ranged from 78.9% to 100% with a range of protocols employed across studies. Investigations such as patch tests and lymphocyte transformation tests have helped in ensuring accurate diagnosis and guided desensitization strategies. Conclusion: Desensitization is an effective strategy for the management of adverse reactions to antituberculosis drugs, particularly in cases of delayed cutaneous adverse reactions.