Sulfasalazine is an important therapeutic agent in the management of chronic
inflammatory bowel disease (CIBD). Unfortunately, adverse reactions to this
drug have been reported in 5-55% of treated patients. These include dose-related side effects like
nausea, malaise, and
headache or
hypersensitivity reactions such as
rash,
fever,
hives,
arthralgia,
hepatitis, etc. Studies in adults with successful reintroduction of
sulfasalazine after a desensitization program have been reported; however, with regard to children, no such data are available. Fourteen children and adolescents (5-16 yr old) diagnosed to have CIBD manifested
hypersensitivity to
sulfasalazine within 2 months of onset of treatment. All had pancolitis--secondary to
Crohn's disease (CD) in four and to
ulcerative colitis (UC) in 10. All of them were on
steroids.
Sulfasalazine was discontinued in all after symptoms of
hypersensitivity developed. Three patients with severe reaction were diagnosed prior to desensitization experience. Desensitization, beginning with 5-50 mg of
sulfasalazine/day, was attempted in the other 11 children. The dose was gradually increased by 5-50 mg increments every 3 days. Desensitization was successful in only five children, who were ultimately able to tolerate 1.5-3.0 g of
sulfasalazine daily again. In the rest (six of 11 patients), oral 5-ASA (
Asacol) was administered, and three could not tolerate it. One of these three with intolerance to
Asacol required
colectomy. One did not tolerate
Asacol or
Dipentum. Our findings suggest that
sulfasalazine desensitization should be attempted in all patients developing
hypersensitivity reactions before trying alternative
therapy.