Tuberculosis (TB) is the most prevalent infectious cause of mortality worldwide. Adverse responses to first-line TB medicines are widespread and have a significant influence on patient outcomes since second-line antibiotics are less effective and more toxic. The current review focuses on the most recent research on epidemiology, examining responses, and restarting medication in individuals whose treatment has been discontinued. According to studies, up to 60% of patients suffer adverse responses after TB therapy; around one-third of these are idiosyncratic and may be related to immunological sensitization. Patients with HIV are at a higher risk. Patch testing is useful for individuals who have severe cutaneous responses; nevertheless, systemic reactions to patch testing are prevalent in HIV patients. Although in-vitro testing is still restricted to specialised facilities, investigations have found drug-specific lymphocyte responses in individuals with cutaneous and hepatic reactions. Desensitization of individuals with severe cutaneous responses has been shown to be possible, but risky.
The management of these patients is still poor. To identify patients at risk, better identification of predisposing variables, such as HLA alleles, is required. Improved in-vitro diagnostics will decrease the need for the patient to be re-exposed to the medication, and optimised desensitisation regimens will increase patient safety when medicines must be re-introduced.
