A Life-Threatening Adverse Reaction During Trimethoprim-Sulfamethoxazole Desensitization in a Previously Hypersensitive Patient Infected with Human Immunodeficiency Virus

Caumes, Éric; Guermonprez, Geraldine; Winter, C.; Katlama, Christine; Bricaire, F.

doi:10.1093/clinids/23.6.1313

Cited by 13 publications

(4 citation statements)

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“…Some reports have described that the rate of adverse effects would decrease via desensitization to the drug [23][24][25]. Koopmans et al [24] suggested that the mechanism of desensitization involved neutralization of IgE antibodies and gradual degranulation of mast cells.…”

Section: Discussionmentioning

confidence: 99%

A dose-escalation regimen of trimethoprim–sulfamethoxazole is tolerable for prophylaxis against Pneumocystis jiroveci pneumonia in rheumatic diseases

Takenaka

Komiya

et al. 2013

Modern Rheumatology

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Section: Discussionmentioning

confidence: 99%

A dose-escalation regimen of trimethoprim–sulfamethoxazole is tolerable for prophylaxis against Pneumocystis jiroveci pneumonia in rheumatic diseases

Takenaka

Komiya

et al. 2013

Modern Rheumatology

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“…There are also adverse reactions that are not similar or identical to the initial hypersensitivity reaction; however, these appear coincidental and the relation to the original reaction remains unclear. Although the occurrence of anaphylaxis in a patient with an initial febrile maculopapular rash is exceptional, such diverse adverse reactions have been observed particularly in HIV‐positive patients . A HIV‐positive child was challenged with TMP‐SMX after having developed a generalized erythema and glossitis and reacted with an anaphylactic reaction to the challenge .…”

Section: Methodsmentioning

confidence: 99%

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

Scherer

Brockow

Aberer

et al. 2013

Allergy

191

173

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Drug hypersensitivity may deprive patients of drug therapy, and occasionally no effective alternative treatment is available. Successful desensitization has been well documented in delayed drug hypersensitivity reactions. In certain situations, such as sulfonamide hypersensitivity in HIV-positive patients or hypersensitivity to antibiotics in patients with cystic fibrosis, published success rates reach 80%, and this procedure appears helpful for the patient management. A state of clinical tolerance may be achieved by the administration of increasing doses of the previously offending drug. However, in most cases, a pre-existent sensitization has not been proven by positive skin tests. Successful re-administration may have occurred in nonsensitized patients. A better understanding of the underlying mechanisms of desensitization is needed. Currently, desensitization in delayed hypersensitivity reactions is restricted to mild, uncomplicated exanthems and fixed drug eruptions. The published success rates vary depending on clinical manifestations, drugs, and applied protocols. Slower protocols tend to be more effective than rush protocols; however, underreporting of unsuccessful procedures is very probable. The decision to desensitize a patient must always be made on an individual basis, balancing risks and benefits. This paper reviews the literature and presents the expert experience of the Drug Hypersensitivity Interest Group of the European Academy of Allergy and Clinical Immunology.Drug hypersensitivity reactions account for more than 15% of all adverse drug reactions and are an important problem in clinical medicine. Drug hypersensitivity reactions may be allergic or nonallergic. Allergic reactions are IgE-or non-IgE-mediated (1). They have also been classified into immediate and nonimmediate (2). Immediate drug hypersensitivity reactions occur within 1 h after drug exposure and can be IgE-mediated or linked to a nonspecific histamine release. Nonimmediate or delayed reactions manifest after more than 1 h. In some of these reactions, a T-cell-mediated Allergy 68 (2013) 844-852

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“…Although very controversial in non‐IgE‐dependent reactions, it is a possible therapeutic option when no alternatives are available in severely ill patients. The cutaneous eruptions sometimes observed during this reaction are most of the time mild [8] but could be serious [9]. The first few weeks after induction appear to be crucial (for the recurrence of hypersensitivity reactions) and no further reactions have been observed after 1 month in our expertise of more than 100 tolerance inductions in HIV‐infected patients hypersensitive to cotrimoxazole [8], nevirapine [5] and nelfinavir [10].…”

Section: Discussionmentioning

confidence: 99%

Long‐term safety and efficacy of nevirapine tolerance induction

Messaad

Reynes

Fabre

et al. 2002

Clin Experimental Allergy

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A Life-Threatening Adverse Reaction During Trimethoprim-Sulfamethoxazole Desensitization in a Previously Hypersensitive Patient Infected with Human Immunodeficiency Virus

Cited by 13 publications

References 0 publications

A dose-escalation regimen of trimethoprim–sulfamethoxazole is tolerable for prophylaxis against Pneumocystis jiroveci pneumonia in rheumatic diseases

A dose-escalation regimen of trimethoprim–sulfamethoxazole is tolerable for prophylaxis against Pneumocystis jiroveci pneumonia in rheumatic diseases

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

Long‐term safety and efficacy of nevirapine tolerance induction

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