5‐Aminosalicylate intolerance causing exacerbation in pediatric ulcerative colitis

Shimizu, Hirotaka; Arai, Katsuhiro; Tang, Julian; Hosoi, Kenji; Funayama, Rie

doi:10.1111/ped.13235

Cited by 12 publications

(13 citation statements)

References 14 publications

(21 reference statements)

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“…Although few studies have evaluated these symptoms in detail, Hanauer et al 6 reported that the incidence of diarrhea was 4.6% and the incidence of hematochezia and fever was 1.4%. Shimizu et al 19 reported that, out of 88 pediatric patients with UC, 11 patients presented allergy to 5-ASA, and the DLST positivity rate was 80%, which is higher than the rate observed in our study. However, differences in the timing and method of the DLST and the observed allergic symptoms may contribute to differences in DLST positivity between studies.…”

Section: Discussioncontrasting

confidence: 90%

Evaluation of the drug-induced lymphocyte stimulation test for diagnosing mesalazine allergy

et al. 2018

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Background/AimsMesalazine is an effective drug for treating ulcerative colitis (UC), but causes allergic symptoms in a few cases. Therefore, the objective of this study was to evaluate the usefulness of the drug-induced lymphocyte stimulation test (DLST) for the diagnosis of mesalazine allergy.MethodsPatients with UC treated with mesalazine with or without a history of associated adverse events (AEs) were enrolled at Kyorin University Hospital from July 2016 to April 2017.ResultsThe DLST was performed in 104 patients with UC, of which 24 had a history of AEs due to mesalazine treatment. The control value of DLST was 337.4±296.3 counts per minute (cpm) in the AE+ group and 408.0±371.9 cpm in the AE− group. The measured value of DLST was 578.8±424.7 cpm in the AE+ group and 476.5±471.8 cpm in the AE− group. The stimulation index (SI) was 243.9%±291.1% in the AE+ group and 119.8%±53.0% in the AE− group. The SI value and DLST positivity were significantly higher in the AE+ group than in the AE− group (P=0.030 and P=0.029, respectively). The test sensitivity and specificity were 0.240 and 0.805, respectively, and the false-positive and false-negative rate was 0.195 and 0.760, respectively.ConclusionsThe DLST for mesalazine showed low sensitivity and high specificity, suggesting that it may be useful for the definitive diagnosis of allergy to mesalazine.

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Section: Discussioncontrasting

confidence: 90%

Evaluation of the drug-induced lymphocyte stimulation test for diagnosing mesalazine allergy

et al. 2018

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“…Cohort) In the microbial analysis, we recruited 181 patients with UC who were aged ≥ 20 years and were in the remission phase (defined as a partial Mayo Clinic score of ≤ 1 without bloody stool). As defined in previous reports, 8,9,14 patients with 5-ASA intolerance were defined as patients who had experienced at least one of the following symptoms in response to 5-ASA administration: headache, digestive symptoms, skin symptoms, or fever.…”

Section: Microbial Analysis Cohort (Keio Uc Microbialmentioning

confidence: 99%

5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis

et al. 2020

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clinical outcomes of UC have been improved by recently developed therapeutic drugs, 2,3 leading to reduced rates of surgical treatment and higher rates of clinical remission compared with previous conventional therapies. 4,5 However, many of these newly developed therapeutic agents still have limited effectiveness, variable responses, potential adverse events caused by immunosuppression, and pharmacoeconomic issues. 6 5-Aminosalicylic acid (ASA) consists of salazosulfapyridine and mesalazine. It is the first-line drug in induction therapy for mild to moderately active UC and in maintenance therapy for

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“…In previous reports, mesalazine intolerance was defined as a case in which any one of the following symptoms occurs after the introduction of mesalazine therapy: headache, gastrointestinal symptoms, skin manifestations, and fever [8][9][10] . In the present study, mesalazine allergy was defined as a case in which symptoms, such as fever, abdominal pain, diarrhea, and bloody stool, appeared or worsened after the introduction of mesalazine therapy and were immediately relieved after the discontinuation of oral mesalazine administration.…”

Section: Diagnosis Of Mesalazine Allergymentioning

confidence: 99%

Mesalazine allergy and an attempt at desensitization therapy in patients with inflammatory bowel disease

Matsumoto

Mashima

2020

Sci Rep

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Mesalazine is a key drug used for remission induction and maintenance therapy in inflammatory bowel disease (IBD). We sometimes encounter patients who develop allergic reactions to the drug and inevitably discontinue treatment. Of 692 patients who received mesalazine for IBD between 2014 and March 2020, 33 diagnosed with mesalazine allergy (43 episodes) were included, and their clinical manifestations were evaluated. For ten patients undergoing desensitization therapy, therapeutic outcomes were evaluated. The incidence of mesalazine allergy was 4.8%. The time from the start of oral medication to allergy onset was 10 ± 5 days for the first allergic attack and 2 ± 1 days for the second and subsequent allergic attacks. The observed clinical symptoms included fever (93%), diarrhea (26%), abdominal pain (23%), and bloody stool (12%). Drug-induced lymphocyte stimulation test was performed in 85% of the patients (28/33), and the sensitivity was 51%. Desensitization therapy with a time-dependent mesalazine granule formulation was successful in nine of the ten patients (90%), allowing them to receive 2000 mg or more of the drug. Fever was a common allergic symptom, and its presence appeared to be useful for distinguishing mesalazine allergy from exacerbation of the primary disease. Desensitization therapy was useful in patients with mesalazine allergy.

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5‐Aminosalicylate intolerance causing exacerbation in pediatric ulcerative colitis

Abstract: The incidence of 5-ASA intolerance was relatively high. Besides the challenge test, elevation of CRP and positive DLST appeared to support the diagnosis of 5-ASA intolerance.

Cited by 12 publications

References 14 publications

Evaluation of the drug-induced lymphocyte stimulation test for diagnosing mesalazine allergy

Evaluation of the drug-induced lymphocyte stimulation test for diagnosing mesalazine allergy

5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis

Mesalazine allergy and an attempt at desensitization therapy in patients with inflammatory bowel disease

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