A Method of Desensitization of Allergy Due to Streptomycin with Prednisone

¹ The Department of Chronic Diseases of the Chest, Philadelphia General Hospital., The V. P. Chest Institute, Delhi University.

1. In the treatment of tuberculosis, allergy due to streptomycin is found in 10 per cent of cases.

2. To identify such allergy, intradermal skin test with 10 milligram streptomycin in 0.1 ml. normal saline is done. Among 150 patients 12 were allergic clinically. Of these 12 patients, 11 (90.7 per cent) reacted to streptomycin skin test. The rest of 138 patients who were not allergic clinically to streptomycin gave negative reactions to skin test.

3. The streptomycin skin test is a delayed type of reaction, which becomes positive in 12 to 24 hours.

4. To desensitize, 50 milligrams of prednisone is given orally daily for one week. After a week, along with 50 mg. prednisone daily streptomycin is given intramuscularly, starting with 10 mg. on the first day and doubled daily up to 800 milligrams. Then 1.0 gram of streptomycin is administered twice weekly. After 1.0 gram has been given twice weekly for four weeks, prednisone is tapered off and stopped, in about two weeks.

5. Before stopping prednisone 20 units of ACTH is given daily intramuscularly. ACTH is gradually tapered off and stopped in eight days.

6. Among four patients allergic to streptomycin and desensitized, three were positive to the first dose of purified protein derivative, one could not be tested due to angioneurotic edema. During prednisone administration all were negative to the same dose of PPD. Four weeks after prednisone was stopped, all were again positive to PPD.