Para-aminosalicylic acid (PAS) desensitization review in a case of multidrug-resistant pulmonary tuberculosis.
METHODS
Tertiary care hospital in the Upper Midwest, United States.


OBJECTIVE
Rapid desensitization to para-aminosalicylic acid (PAS) in a patient with previous hypersensitivity reaction and a review of published PAS desensitization protocols.


METHODS
Composition and implementation of a short-course PAS desensitization protocol for a 34-year-old woman with multidrug-resistant (MDR) pulmonary tuberculosis, incorporating published experiences of PAS desensitization over the past 50 years.


RESULTS
We composed a protocol and successfully desensitized our patient to PAS (Paser granules). By starting with a low dose (50 mg), then doubling the PAS dose on each successive day, our patient was able to tolerate full dose in 1 week. No steroids were required and no adverse reactions were encountered. Previous published PAS desensitization protocols used starting doses of 10-500 mg, desensitization time ranges from 7 to 54 days and commonly used steroids or corticotropin.


CONCLUSIONS
Rapid desensitization to PAS can be successfully conducted within 1 week without the use of steroids or corticotropin. Given the limited number of drugs available for many patients with MDR-TB, desensitization to PAS is a valid alternative to drug discontinuation for patients with hypersensitivity reactions.
Wilson
J W
JW
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. wilson.john@mayo.edu
Kelkar
P
P
Frigas
E
E
D000328:Adult; D010131:Aminosalicylic Acid / Q000008:administration & dosage / Q000276:immunology*; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000276:immunology*; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000276:immunology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000276:immunology
D000995:Antitubercular Agents; D010131:Aminosalicylic Acid