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Rifampin hypersensitivity in a two year-old child with successful rapid oral desensitization

A two year, 10 month-old child was referred to a tertiary allergy clinic following an adverse reaction to rifampin. Her mother had isoniazid-resistant pulmonary tuberculosis. The child was born in Canada, was asymptomatic, had a normal chest x-ray and liver enzymes. Mantoux induration was 17 mm. The child was prescribed oral rifampin, 150 mg per day for 3 months. Thirty minutes after ingesting the fifth dose, she developed swelling of the lips, eyes and face; and a pruritic rash to the extremities and face. Anti-histamine was administered: the rash resolved over thirty minutes and facial swelling over 2-3 hours. There were no other IgE-mediated symptoms. Rifampin was discontinued. Past history was negative for atopy, adverse drug reactions, and food allergies.

Intravenous rifampin (600 mg/mL) was used for skin prick and intradermal testing. The patient was admitted to hospital and intravenous access established. Skin prick test results were negative to undiluted rifampin and saline; the histamine response was positive (5 mm). Intradermal testing was performed at 15-minute intervals with dilutions of 1:10,000, 1:1000 and 1:100. The 1:100 dilution test was positive.

Rapid desensitization to oral rifampin was performed over 3.25 hours. The first dose was 1/10,000 of the total dose. Thirteen incremental doses were administered every 15 minutes until a cumulative dose of 151.08 mg had been ingested (Table 1). No adverse events were noted. The child was subsequently continued on a dose of oral rifampin 75 mg twice daily and has not had subsequent reactions.

This case highlights the rare occurrence of rifampin hypersensitivity in a child. Desensitization was motivated by the lack of alternative therapies. Rifampin desensitization protocols preciously reported have occurred predominantly in the adult population over several days. We describe a case of rapid oral desensitization to rifampin in a two year-old child.

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Correspondence to KJ Hildebrand.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Hildebrand, K., Hummel, D. Rifampin hypersensitivity in a two year-old child with successful rapid oral desensitization. All Asth Clin Immun 6, P22 (2010). https://doi.org/10.1186/1710-1492-6-S1-P22

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Keywords

  • Food Allergy
  • Rifampin
  • Skin Prick Test
  • Pulmonary Tuberculosis
  • Allergy Clinic