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Mesalazine allergy in a boy with ulcerative colitis: clinical usefulness of mucosal biopsy criteria. | LitMetric

AI Article Synopsis

  • 5-Aminosalicylic acid, particularly mesalazine, is commonly used as the first-line treatment for ulcerative colitis (UC) but can cause allergic reactions in some patients.
  • A 13-year-old boy with a suspected allergy to mesalazine experienced symptom exacerbation, which was later confirmed through a drug lymphocyte stimulation test.
  • After switching to salazosulfapyridine and adding prednisolone, the patient achieved remission and remained stable, highlighting the importance of considering drug allergies in UC treatment.

Article 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.

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Source
http://dx.doi.org/10.1007/s12328-016-0675-2DOI Listing

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