Six-hour trimethoprim-sulfamethoxazole–graded challenge in HIV-infected patients
Background: Hypersensitivity reactions to trimethoprim-sulfamethoxazole (TMP-SMX) are very common in HIV-infected patients, leading to drug discontinuation. However, it is the drug of choice as prophylaxis for Pneumocystis carinii pneumonia. Objectives: We sought to determine the safety and long-ter...
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Veröffentlicht in: | Journal of allergy and clinical immunology 1998-12, Vol.102 (6), p.1033-1036 |
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Sprache: | eng |
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Zusammenfassung: | Background: Hypersensitivity reactions to trimethoprim-sulfamethoxazole (TMP-SMX) are very common in HIV-infected patients, leading to drug discontinuation. However, it is the drug of choice as prophylaxis for
Pneumocystis carinii pneumonia. Objectives: We sought to determine the safety and long-term efficacy of a 6-hour TMP-SMX–graded challenge in a group of hypersensitive HIV-infected patients.
Methods: Forty-four consecutive HIV-infected patients with documented TMP-SMX hypersensitivity were seen in our outpatient allergy department. They ingested 12 doses of increasing amounts of TMP-SMX at half-hour intervals. Thereafter, they took 80/400 mg TMP-SMX daily and were advised to “treat through” every nonbullous cutaneous adverse reaction.
Results: All 44 patients tolerated the procedure without any adverse reactions during the day of challenge. Eleven of the 44 patients experienced mild hypersensitivity reactions on days 1 to 2 (8 patients) and 8 to 10 (3 patients), consisting mainly on a 1-day pruritic maculopapular eruption. Two patients stopped TMP-SMX at day 1, and 2 stopped it at days 10 and 15, giving an overall success rate at 1 month of 91% (40 of 44). Two were successfully rechallenged late. After a median follow-up of 10 months, 42 patients were taking TMP-SMX without any adverse reaction, giving an overall success rate of 95%.
Conclusions: A 6-hour graded challenge with cautious “treating through” of mild reactions enables more patients to take TMP-SMX and is safe and effective. (J Allergy Clin Immunol 1998;102:1033-6.) |
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ISSN: | 0091-6749 1097-6825 |
DOI: | 10.1016/S0091-6749(98)70343-4 |