Successful Treatment of Allopurinol Desensitization in Gouty Arthritis Patient with Allopurinol and Colchicine Drug Allergies: A Case Report

Abstract

Thai male 51 year-old diabetic mellitus type 2 with gout, known to also had history of gouty arthritis
with allopurinol induced maculopapular rash, presented with clinically diagnosed left ankle arthritis at a
private clinic. The patient was treated with colchicine 1.2 mg/day. About 30 minutes after receiving colchicine, the patient developed urticarial rash, oral and eyelids mucosal swelling and obvious dyspnea. The patient was admitted to the hospital for proper management as these symptoms indicated suspicious colchicine induced anaphylactic shock with acute respiratory failure. Course management: the patient was given endotracheal intubation and respiratory support, epinephrine, antihistamine and corticosteroid therapy. Colchicine was stopped. The patient had recurring arthritis and high serum uric acid levels, and the other urate-lowering agents were not available, so the only available treatment was allopurinol therapy. Allopurinol desensitization protocol was applied by the dosage re-challenge technique for approximately 21 days until there were no complications at a therapeutic dose. Finally, the patient was given allopurinol 450 mg once daily to control serum uric acid (to less than 5.0 mg/dl). The patient had no allergic symptoms such as maculopapular rash or urticaria after treatment.