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The incidence of TB is highest in Low\u2010Middle Income countries (LMICs). Prompt institution of, and compliance with, therapy are cornerstones for a favourable outcome in TB and to mitigate the risk of multiple drug resistant (MDR)\u2010TB, which is challenging to treat. There is some evidence that adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) to anti\u2010TB drugs occur in over 60% and 3%\u20134% of patients respectively. Both ADRs and HSRs represent significant barriers to treatment adherence and are recognised risk factors for MDR\u2010TB. HSRs to anti\u2010TB drugs are usually cutaneous and benign, occur within few weeks after commencement of therapy and are likely to be T\u2010cell mediated. Severe and systemic T\u2010cell mediated HSRs and IgE mediated anaphylaxis to anti\u2010TB drugs are relatively rare, but important to recognise and treat promptly. T\u2010cell\u2010mediated HSRs are more frequent amongst patients with co\u2010existing HIV infection. Some patients develop multiple sensitisation to anti\u2010TB drugs. Whilst skin tests, patch tests and in vitro diagnostics have been used in the investigation of HSRs to anti\u2010TB drugs, their predictive value is not established, they are onerous, require specialist input of an allergist and are resource\u2010dependent. This is compounded by the global, unmet demand for allergy specialists, particularly in low\u2010income countries (LICs)\/LMICs and now the challenging circumstances of the severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102) pandemic. This narrative review provides a critical analysis of the limited published evidence on this topic and proposes a cautious and pragmatic approach to optimise and standardise the management of HSRs to anti\u2010TB drugs. This includes clinical risk stratification and a dual strategy involving sequential re\u2010challenge and rapid drug desensitisation. Furthermore, a concerted international effort is needed to generate real\u2010time data on ADRs, HSRs, safety and clinical outcomes of these interventions.<\/jats:p>","DOI":"10.1111\/cea.14084","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T02:21:54Z","timestamp":1640226114000},"page":"375-386","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Practical management of suspected hypersensitivity reactions to anti\u2010tuberculosis drugs"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2213-5574","authenticated-orcid":false,"given":"William Hywel","family":"Bermingham","sequence":"first","affiliation":[{"name":"Department of Allergy &amp; Immunology University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmeet","family":"Bhogal","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sowmya","family":"Arudi Nagarajan","sequence":"additional","affiliation":[{"name":"Department of Allergy and Immunology Kanagaroo Care Paediatric Hospital  Bengaluru India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leman","family":"Mutlu","sequence":"additional","affiliation":[{"name":"Department of Allergy &amp; Immunology University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reham Mohamed","family":"El\u2010Shabrawy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Zagazig University  Zagazig Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Madhan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice JSS College of Pharmacy JSS AHER  Mysuru India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma Maheswari","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine St Johns Medical College  Bengaluru India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandakolathur Ramaswamy","family":"Murali","sequence":"additional","affiliation":[{"name":"Division of Allergy and Clinical Immunology Department of Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanath Thushara","family":"Kudagammana","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Peradeniya  Peradeniya Sri Lanka"},{"name":"Teaching Hospital Peradeniya  Peradeniya Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Departments of Clinical Pharmacology Dhulikhel Hospital Kathmandu University Hospital  Dhulikhel Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stevent","family":"Sumantri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Universitas Pelita Harapan Siloam Academic Hospital Lippo Village  Tangerang Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devasahayam Jesudas","family":"Christopher","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Christian Medical College  Vellore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padukudru Anand","family":"Mahesh","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine JSS Medical College JSSAHER  Mysuru India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Dedicoat","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamidipudi Thirumala","family":"Krishna","sequence":"additional","affiliation":[{"name":"Department of Allergy &amp; Immunology University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"},{"name":"Institute of Immunology and Immunotherapy University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,20]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"World Health Organization.Global Tuberculosis Report 2020. 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