title: Mesalazine allergy in a boy with ulcerative colitis: clinical usefulness of mucosal biopsy criteria.
abstract: 5-Aminosalicylic acid preparations have been used as first-line drugs for treatment of ulcerative colitis (UC). However, some patients with UC present with exacerbation of symptoms because of allergy to mesalazine. Diagnosis of mesalazine allergy in active UC may be challenging because its symptoms mimic those of UC. Here we describe a 13-year-old boy with mesalazine allergy who achieved remission when his medication was changed from mesalazine to salazosulfapyridine. During his clinical course mesalazine was prescribed twice, and on each occasion exacerbation of the symptoms occurred. We considered a diagnosis of mesalazine allergy, and this was confirmed by a drug lymphocyte stimulation test; the result for salazosulfapyridine was negative. On the basis of criteria involving simple mucosal biopsy combined with endoscopy for predicting patients with UC who would ultimately require surgery, we considered that the UC in this case might be susceptible to steroid treatment, and we therefore treated the patient with salazosulfapyridine and prednisolone. Shortly afterwards, remission was achieved and the patient has remained in good condition on salazosulfapyridine alone. When treating patients with mesalazine, the possibility of allergy should always be borne in mind, especially when the clinical course is inconsistent with the results of biopsy.
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Shoya
authors: S
authors: Wada
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. h-kumagai@jichi.ac.jp.
authors: Hideki
authors: H
authors: Kumagai
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Koji
authors: K
authors: Yokoyama
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Takane
authors: T
authors: Ito
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Akihiko
authors: A
authors: Miyauchi
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Saori
authors: S
authors: Sakamoto
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Tomoyuki
authors: T
authors: Imagawa
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Janyerkye
authors: J
authors: Tulyeu
authors: Department of Pathology and Laboratory Medicine, Hirosaki City Hospital, Hirosaki, Aomori, Japan.
authors: Masanori
authors: M
authors: Tanaka
authors: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors: Takanori
authors: T
authors: Yamagata
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D057915:Drug Substitution; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D019804:Mesalamine / Q000009:adverse effects* / Q000627:therapeutic use; D012460:Sulfasalazine / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D012460:Sulfasalazine; D019804:Mesalamine
keywords: 5-ASA; Aminosalicylates; Biopsy; Drug lymphocyte stimulation test; Endoscopy; Histological criteria; Inflammatory bowel disease; Pediatric ulcerative colitis