Sulphadiazine desensitization in AIDS patients

Fégueux, S.; Jruchis, P. De; Ballout, H.; Maslo, Caroline; Matheron, Sophie; Coulaud, J P

doi:10.1097/00002030-199110000-00028

Cited by 9 publications

(6 citation statements)

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“…Fégueux et al. reported an HIV‐positive female patient with cerebral toxoplasmosis who underwent a desensitization procedure with sulfadiazine over 6 days under premedication with prednisolone and antihistamines. After having reached the therapeutic dose of sulfadiazine, the corticosteroid was slowly tapered until day 18.…”

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

189

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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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

189

173

View full text Add to dashboard Cite

show abstract

“…When an adverse reaction occurs, the drug in question needs to be withdrawn immediately in order to minimize its effects. Reintroducing the sensitized drug should be avoided because moresevere hypersensitivity reactions or even life-threatening conditions such as Stevens-Johnson syndrome or toxic epidermal necrolysis can occur [14]. In addition, the development of cross-reactivity to other AEDs reportedly occurs in 40–58% of the cases [19,24].…”

Section: Hypersensitivity Reactionmentioning

confidence: 99%

Antiepileptic Drugs in Children : Current Concept

Lee

2019

J Korean Neurosurg Soc

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An epileptic seizure is defined as the transient occurrence of signs and/or symptoms due to abnormally excessive or synchronous neuronal activity in the brain. The type of seizure is defined by the mode of onset and termination, clinical manifestation, and by the abnormal enhanced synchrony. If seizures recur, that state is defined as epilepsy. Antiepileptic drugs (AEDs) are the mainstay of treatment. Knowledge about initiating and maintaining adequate AEDs is beneficial for the clinician who treats children with epilepsy. This article will delineate the general principles for selecting, introducing, and discontinuing AEDs and outline guidelines for monitoring adverse effects. In general, AED therapy following a first unprovoked seizure in children is not recommended. However, treatment should be considered after a second seizure. In children and adolescents, if they are seizure-free for at least 2 years, attempts to withdraw medication/s should be made, taking into account the risks vs. benefits for the individual patient. The decision on when and what AED to use should be tailored according to the patient. For optimal treatment, the selection of adequate AEDs can be achieved by considering the precise definition of the patient’s seizure and epilepsy syndrome. Continuous monitoring of both therapeutic and adverse effects is critical for successful treatment with AEDs.

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“…'^^ Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome are contraindications to readministration of TMP-SMX; however, protocols giving increased dosages for prophylaxis in HIVinfected persons in the ambulatory setting were successful. [143][144][145][146][147][148][149][150][151][152][153][154][155][156][157] The desensitization regimen at our hospital is shown in Table 2. The mechanism of increased dosages is presumed to be desensitization.…”

Section: Tmp-smx Desensitization Regimensmentioning

confidence: 99%

“…Desensitization was successful in 205 of 243 patients tested who experienced fever and rash in association with prior use of this agent. [143][144][145][146][147][148][149][150][151][152][153][154][155][156][157] The initial dilution of TMP-SMX in published reports varies widely; two reports used an initial solution that was a dilution of SMX of 1 to 1 million. In addition, the duration of desensitization varies (range 5 hrs-30 days).…”

Section: Tmp-smx Desensitization Regimensmentioning

confidence: 99%

Advances in the Treatment and Prophylaxis ofPneumocystis cariniiPneumonia

Warren,

George,

You

et al. 1997

Pharmacotherapy

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Pneumocystis carinii pneumonia (PCP) is the most common illness associated with the acquired immunodeficiency syndrome (AIDS) in the United States and also occurs in immunocompromised persons not infected with the human immunodeficiency virus. Several advances have taken place in the treatment and prophylaxis of PCP, with most clinical trials conducted in patients with AIDS. Treatment of choice is trimethoprim‐sulfamethoxazole (TMP‐SMX). Desensitization regimens are available for those who have a fever or rash associated with the agent. Patients with severe PCP who cannot tolerate TMP‐SMX may be treated successfully with pentamidine or trimetrexate. Those with mild to moderate disease may receive dapsone‐trimethoprim, clindamycin‐primaquine, or atovaquone if they cannot take TMP‐SMX. Adjunctive therapy with corticosteroids improves the outcome in patients with AIDS and severe PCP. (Pharmacotherapy 1997;17(5):900–916)

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Sulphadiazine desensitization in AIDS patients

Cited by 9 publications

References 0 publications

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

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

Antiepileptic Drugs in Children : Current Concept

Advances in the Treatment and Prophylaxis ofPneumocystis cariniiPneumonia

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