Six-hour trimethoprim-sulfamethoxazole-graded challenge in HIV-infected patients

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:102

Article

Demoly, P ; Messaad, D ; Sahla, H ; Fabre, J ; Faucherre, V ; André, P ; Reynes, J ; Godard, P ; Bousquet, J

关键词: trimethoprim-sulfamethoxazole;    cotrimoxazole;    desensitization;    graded challenge;    HIV;    tolerance;    hypersensitivity;   

DOI  :  10.1016/S0091-6749(98)70343-4

来源: Elsevier

【 摘 要 】

Background: Hypersensitivity reactions to trimethoprim-sulfamethoxazole (TMP-SR IX) 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-np 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.

【 授权许可】

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