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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References
Talley NJ, Abreu MT, Achkar JP, Bernstein CN, Dubinsky MC, Hanauer SB, et al. An evidence-based systematic review on medical therapies for inflammatory bowel disease. Am J Gastroenterol. 2011;106(Suppl):S2–25.
Iofel E, Chawla A, Daum F, Markowitz J. Mesalamine intolerance mimics symptoms of active inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2002;34:73–6.
Shimodate Y, Takanashi K, Waga E, Fujita T, Katsuki S, Nomura M. Exacerbation of bloody diarrhea as a side effect of mesalamine treatment of active ulcerative colitis. Case Rep Gastroenterol. 2011;5:159–65.
Tanaka M, Kusumi T, Oshitani N, Nishigami T, Iwao Y, Hatada Y, Sugita A, Yao T, Takano M, Iizuka B, Mukai M, Maeda K, Fukuda S, Morita T, Hara M, Saito H, Kudo H. Validity of simple mucosal biopsy criteria combined with endoscopy predicting patients with ulceractive colitis ultimately requiring surgery: a multicenter study. Scand J Gastroenterol. 2003;38:594–8.
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis: a randomized study. N Engl J Med. 1987;317:1625–9.
Hanauer S, Schwartz J, Robinson M, Roufail W, Arora S, Cello J, Safdi M. Mesalamine capsules for treatment of active ulcerative colitis: results of a controlled trial. Pentasa Study Group. Am J Gastroenterol. 1993;88:1188–97.
Möbs C, Pfützner W. Cellular in vitro diagnosis of adverse drug reactions. Allergo J Int. 2014;23:164–71.
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Shoya Wada, Hideki Kumagai, Koji Yokoyama, Takane Ito, Akihiko Miyauchi, Saori Sakamoto, Tomoyuki Imagawa, JanyerkyeTulyeu, Masanori Tanaka and Takanori Yamagata declare that they have no conflict of interest.
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Wada, S., Kumagai, H., Yokoyama, K. et al. Mesalazine allergy in a boy with ulcerative colitis: clinical usefulness of mucosal biopsy criteria. Clin J Gastroenterol 9, 302–305 (2016). https://doi.org/10.1007/s12328-016-0675-2
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DOI: https://doi.org/10.1007/s12328-016-0675-2