Antituberculosis drug-induced hypersensitivity: clinical characteristics and risk factors

Background Antituberculosis drugs can cause hypersensitivity reactions that interrupt treatment and increase morbidity. Early identification and management are essential to prevent complications and drug resistance. Objective To evaluate the clinical characteristics, risk factors, and outcomes of antituberculosis drug-induced hypersensitivity reactions over a 10-year period in a tertiary referral center. Methods We retrospectively analyzed 449 patients hospitalized for antituberculosis drug-induced hypersensitivity between 2015 and 2024. A control group of 478 tuberculosis patients without hypersensitivity was included. Demographic features, comorbidities, hypersensitivity types, causative drugs, and treatment outcomes were compared. Results The prevalence of hypersensitivity was 12.1%. Female gender, older age, Turkish nationality, and history of other drug allergies were significant risk factors. Type 1 reactions (77.7%) were more common and associated with shorter treatment interruption and higher cure rates. Pyrazinamide was the most frequently implicated drug. Desensitization was successful in the majority of patients. Conclusion This large cohort study highlights key risk factors and clinical outcomes in tuberculosis drug hypersensitivity. Close monitoring of high-risk patients in the early treatment phase may reduce delays and improve outcomes.