A clinico-epidemiological study of allergens in patients with dermatitis.

Sir, We greatly appreciate your interest in our article. The study by Sayani et al. (2005) has shown that there is no correlation between the TPMT activity and the development of azathioprine induced adverse events. Therefore estimation of TPMT levels to predict adverse events seems unnecessary. The apprehension of using 300 mg pulse doses of azathioprine in the absence of TPMT assessment also seems misplaced. There may be some other factors responsible for myelosuppression; therefore regular monitoring of complete blood cell counts throughout the treatment is essential. We have used azathioprine in a large number of patients for prolonged durations and found it clinically and biochemically safe. Pulse doses of azathioprine, administered as 300 mg in a month along with daily doses of azathioprine have also been found to be safe and effective. Therefore 300 mg weekly pulse doses of azathioprine can be safely used. However we recommend close regular monitoring of laboratory parameters, particularly complete blood counts and liver function tests to determine any azathioprine induced adverse events.