Published: 2022-11-23

Safety of oral graded challenges as a diagnostic approach hypersensitivity reaction to anti-tuberculosis drugs: a case report

Putu Aditya Dwipayana, Ketut Suryana


Tuberculosis (TB) still becomes a significant health problem in developing countries, especially in Indonesia. Allergy to antitubercular drugs is a real hindrance to the management of TB. The first-line anti-TB drug (ATD) is still the most effective TB drug, but it can have some side effects. One of these side effects is drug hypersensitivity reactions (DHR) which can affect a patient's compliance. The recommended diagnostic approach to DHR is a graded challenge by introducing drugs safely and optimally under a threshold dose until the usual daily dose is reached. We present a case of DHR to ATB drug and oral graded challenge as the diagnosis approach.


Graded challenges, Safety, DHR

Full Text:



Susilawati Tri Nugraha, Larasati riska. A recent update of the diagnostic methods for tuberculosis and their applicability in Indonesia: a narrative review. Med J Indones. 2019;28:284-91.

Kemenkes. TB Dashboard. Available at: Accessed on 21 September 2022.

WHO/health-topics/tuberculosis. Available at: Accessed on 21 September 2022.

Gülbay BE, Gürkan OU, Yildiz OA. Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis. Respir Med. 2006;100(10):1834-42.

Iammatteo M, Alvarez Arango S, Ferastraoaru D. Safety and Outcomes of Oral Graded Challenges to Amoxicillin without Prior Skin Testing. J Allergy Clin Immunol Pract. 2019;7(1):236-43.

Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259-273.

Böhm R, Proksch E, Schwarz T, Cascorbi I. Drug Hypersensitivity. Dtsch Arztebl Int. 2018;115(29-30):501-12.

Kim MH, Lee JM. Diagnosis and management of immediate hypersensitivity reactions to cephalosporins. Allergy Asthma Immunol Res. 2014;6(6):485-95.

Farazi A, Sofian M, Jabbariasl M, Keshavarz S. Adverse reactions to antituberculosis drugs in Iranian tuberculosis patients. Tuberc Res Treat. 2014;2014:1-6.

Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A et al. General considerations on rapid desensitization for drug hypersensitivity-a consensus statement. Allergy. 2010;65:1357-66.