Doctors Clinical-Decision making Algorithm for Allergy to Anti-Tuberculosis Drugs in Tunisia

The prevalence of the allergic reactions dur to anti-tuberculosis treatment varies from (4%) to (5%) in exposed patients and can increase up to (25%) in HIV patients. We aimed to find out an optimal and a rational approach to manage the anti-tuberculosis drugs allergy according to our socio-economic context. This is a prospective, cross-sectional study including physicians (pulmonologists, dermatologists…) experienced in this field. We created a semi-structured questionnaire on "Google Forms ». Most of them (61.6%) reported delayed hypersensitivity reactions. The treatment may result in mild to moderate allergic reaction such as pruritus, urticaria, skin rash.(44.4%) treated patients with severe allergic reactions. Most experts reported Dress syndrome (66%). Anaphylactic shock was also noted (13%). The most common drugs reported were rifampin, pyrazinamide and isoniazid. In case of a strong clinical suspicion, the diagnosis of allergy to anti-tuberculosis drugs is retained. No additional examination is currently recommended. Some experts use prick tests to document the allergic reaction. Then, a decision algorithm is established. They start by stopping the anti-tuberculosis treatment until the symptoms disappear. Then, a reintroduction test is performed. If the allergy concerns a major anti-tuberculosis treatment, they recommend oral desensitization in order to induce tolerance. In the case of severe allergic reactions, permanent discontinuation of anti-tuberculosis treatment seems reasonable. To conclude, allergic reactions to anti-tuberculosis treatment are often unpredictable and potentially serious. Rigorous monitoring of patients is necessary in routine practice.