Successful Outpatient Graded Administration of Trimethoprim-Sulfamethoxazole in Patients Without HIV and With a History of Sulfonamide Adverse Drug Reaction

Pyle, Regan; Butterfield, Joseph H.; Volcheck, Gerald W.; Podjasek, Jenna C.; Rank, Matthew A.; Li, James T.C.; Harish, Amitha; Poe, Kimberly; Park, Miguel A.

doi:10.1016/j.jaip.2013.11.002

Cited by 39 publications

(18 citation statements)

References 32 publications

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“…Whilst desensitization is an appropriate alternative approach in delayed hypersensitivity (18), the immunological mechanism for tolerance remains unknown (19), and it carries the logistical concerns of acute care admission and additional cost. The benefits of TMP-SMX over alternative agents include the additional coverage of toxoplasmosis (20, 21), possibly nocardiosis (22), and potential risk reduction of sepsis and UTIs in RTRs (23).…”

Section: Discussionmentioning

confidence: 99%

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Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients

Urbancic

Ierino

Phillips

et al. 2018

American Journal of Transplantation

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While trimethoprim-sulfamethoxazole is considered first-line therapy for Pneumocystis pneumonia prevention in renal transplant recipients, reported adverse drug reactions may limit use and increase reliance on costly and less effective alternatives, often aerosolized pentamidine. We report our experience implementing a protocolized approach to trimethoprim-sulfamethoxazole adverse drug reaction assessment and rechallenge to optimize prophylaxis in this patient cohort. We retrospectively reviewed 119 patients receiving Pneumocystis pneumonia prophylaxis prior to and after protocol implementation. Forty-two patients (35%) had 48 trimethoprim-sulfamethoxazole adverse drug reactions documented either at baseline or during the prophylaxis period, of which 83% were non-immune-mediated and 17% were immune-mediated. Significantly more patients underwent trimethoprim-sulfamethoxazole rechallenge after protocol implementation (4/22 vs. 23/27; P=0.0001), with no recurrence of adverse drug reactions in 74%. In those who experienced a new or recurrent reaction (26%), all were mild and self-limiting with only 1 recurrence of an immune-mediated reaction. After protocol implementation, aerosolized pentamidine-associated costs were reduced. The introduction of a standard approach to trimethoprim-sulfamethoxazole rechallenge in the context of both prior immune and non-immune-mediated reactions was safe and successful in improving the uptake of first-line Pneumocystis pneumonia prophylaxis in renal transplant recipients.

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Section: Discussionmentioning

confidence: 99%

“…In both our RTR cohort and other patient groups, 17,18 rechallenge with TMP-SMX in patients with a history of benign MPE has proven successful. While desensitization is an appropriate alternative approach in delayed hypersensitivity, 18 the immunological mechanism for tolerance remains unknown, 19 and it carries the lo-…”

Section: Discussionmentioning

confidence: 99%

Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients

Urbancic

Ierino

Phillips

et al. 2018

American Journal of Transplantation

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“…Drug desensitization protocols and reviews of approaches were presented in a number of studies. [84][85][86][87] Of clinical note, a case series suggested that intravenous use of methylprednisolone sodium succinate resulted in allergic reactions in children with milk allergy that was traced to likely milk protein contamination of lactose in this preparation, 88 and a case report added to the limited literature with the suggestion that antihistamines can induce urticaria. 89 Several insights of importance for diagnosis and potential future management of drug allergy were reported.…”

Section: Drug Allergymentioning

confidence: 99%

Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2014

Sicherer

Leung

2015

Journal of Allergy and Clinical Immunology

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This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2014. Studies on food allergy suggest worrisomely high rates of peanut allergy and food-induced anaphylaxis-related hospitalizations. Evidence is mounting to support the theory that environmental exposure to peanut, such as in house dust, especially with an impaired skin barrier attributed to atopic dermatitis (AD) and loss of function mutations in the filaggrin gene, is a risk factor for sensitization and allergy. Diagnostic tests are improving, with early studies suggesting the possibility of developing novel cellular tests with increased diagnostic utility. Treatment trials continue to show the promise and limitations of oral immunotherapy, and mechanistic studies are elucidating pathways that might define the degree of efficacy of this treatment. Studies have also provided insights into the prevalence and characteristics of anaphylaxis and insect venom allergy, such as suggesting that baseline platelet-activating factor acetylhydrolase activity levels are related to the severity of reactions. Advances in drug allergy include identification of HLA associations for penicillin allergy and a microRNA biomarker/mechanism for toxic epidermal necrolysis. Research identifying critical events leading to skin barrier dysfunction and the polarized immune pathways that drive AD have led to new therapeutic approaches in the prevention and management of AD.

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“…Significantly, a large proportion of AALs were type A (23%), amendable to immediate "delabeling." In LTRs with a sulfonamide allergy, TMP-SMX or dapsone may also have been unnecessarily avoided if one considers that antibiotic sulfonamide cross-reactivity is lower than previously thought (5) and TMP-SMX desensitization or rechallenge is often effective (6,7).…”

mentioning

confidence: 99%

Antibiotic Allergy Labels in a Liver Transplant Recipient Study

Khumra

Chan

Urbancic

et al. 2017

Antimicrob Agents Chemother

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P atient-reported antibiotic allergies (so-called antibiotic allergy labels [AALs]) are associated with suboptimal prescribing and inferior clinical outcomes, especially in the immunocompromised (1, 2). The prevalence, type, and impact of AALs in liver transplant recipients (LTRs) remain ill defined. We report on AALs and their impact on a cohort of Australian LTRs.A retrospective matched-cohort study was conducted over a 5-year period (2010 to 2015) at an Australian liver transplant center (Austin Health). Using a departmental liver transplant database, LTRs with an AAL (AAL group) were identified. The same number of matched controls (LTRs without an antibiotic allergy label [non-AAL group]) were randomly selected for comparison. AALs were evaluated and classified as type A adverse drug reactions (ADRs; nonimmune mediated), type B ADRs (immune mediated), or of unknown type (3). Baseline demographics, transplant history, and infection-related admission data were collected. From the time of transplant until 12 months afterward, antibiotics administered during infection-related admissions and their duration of administration were recorded. Readmission, intensive-care unit (ICU) admission, Clostridium difficile infection (CDI), multidrug-resistant (MDR) organism isolation, and mortality rate were captured. An MDR organism was defined as a bacterium resistant to at least one agent in three or more antibiotic classes (4).Of 313 LTRs, 51 (16%) had Ն1 AAL. Females predominated in the AAL group (75% female versus 25% male; P ϭ 0.003), but there was no statistically significant differences in the rates of ICU admission and mortality between males and females (see Table S1 in the supplemental material). Seventy-seven AALs were recorded; of these, 23% (18/77) were type A ADRs, 66% were type B ADRs (51/77), and 10% (8/77) were of unknown type. Of the type A ADRs, 72% (13/18) were gastrointestinal upset, and of the type B ADRs, 6% (3/51) were severe cutaneous ADRs, 55% (28/51) were maculopapular exanthema, 35% (18/51) were anaphylaxis, urticaria, or angioedema, and 4% (2/51) were other reactions. The antibiotics implicated in AALs are demonstrated in Fig. 1

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Successful Outpatient Graded Administration of Trimethoprim-Sulfamethoxazole in Patients Without HIV and With a History of Sulfonamide Adverse Drug Reaction

Cited by 39 publications

References 32 publications

Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients

Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients

Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2014

Antibiotic Allergy Labels in a Liver Transplant Recipient Study

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