Mesalazine formulation intolerance due to suspected excipient allergy in the treatment of ulcerative colitis: a case rep
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CASE REPORT
Mesalazine formulation intolerance due to suspected excipient allergy in the treatment of ulcerative colitis: a case report Yoshinori Arai1 · Maiko Ogawa1 · Fumitsugu Yamane1 · Natsuki Sumiyoshi1 · Rikako Arimoto1 · Yoshitaka Ando1 · Daisuke Endo1 · Tatsuya Nakada1 · Ichiro Sugawara1 · Hiroshi Yokoyama1 · Keiko Shimoyama2 · Hiroko Inomata2 · Yosuke Kawahara2 · Masayuki Kato2 · Seiji Arihiro1 · Atsushi Hokari1 · Masayuki Saruta3 Received: 14 July 2020 / Accepted: 18 August 2020 © The Author(s) 2020
Abstract Mesalazine formulations are essential for treating ulcerative colitis (UC), and intolerance to these formulations complicates the treatment of this condition. Some cases of mesalazine formulation intolerance are caused by the excipients rather than the active ingredient mesalazine. Therefore, mesalazine administration can be continued in such cases by changing the mesalazine formulation. This report describes a case of intolerance to mesalazine in which UC was effectively treated by switching mesalazine formulations. A drug-induced lymphocyte stimulation test suggested that allergy to the additive povidone was the cause of mesalazine formulation intolerance. This is the first case study to identify an additive that caused mesalazine formulation intolerance. Keywords Ulcerative colitis · Mesalazine formulation intolerance · Excipient · Drug-induced lymphocyte stimulation test
Introduction Ulcerative colitis (UC) is an inflammatory disorder of unknown etiology that causes colonic inflammation [1–3]. If left untreated, the condition follows a remitting and recurring course throughout the patient’s lifetime, and the number of cases around the world is increasing [4]. Maintaining remission improves quality of life (QOL) and decreases the risk of carcinogenesis [5, 6]. Mesalazine formulations are essential for treating UC [7, 8]; however, intolerance to these drugs complicates the maintenance of remission, promoting recurrence and increasing the risk of carcinogenesis. Some cases of intolerance to mesalazine formulations are caused * Yoshinori Arai [email protected] 1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, ‑41‑2 Aoto, Katsushika‑ku, Tokyo 105‑8461, Japan
2
Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan
3
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
by excipients, rather than the active ingredient mesalazine, and treatment can be continued by changing the mesalazine formulation. This report describes a case of mesalazine formulation intolerance, where a drug-induced lymphocyte stimulation test (DLST) suggested that allergy to the additive povidone was the cause of the intolerance. To our knowledge, this is the first report to identify an additive that caused mesalazine formulation intolerance. Switching mesalazine formulations was effective in this case.
Case report The pa
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