Zidovudine-related erythroderma and successful desensitization: A case report☆, ☆☆, ★

Duque, S.; Delapuente, J C; Rodríguez, Francisco Quesada; Fernández-Pellón, L.; Maquiera, E.; Jerez, J.

doi:10.1016/s0091-6749(96)70248-8

Cited by 22 publications

(7 citation statements)

References 3 publications

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“…There are a few reported cases on one or several tuberculostatic drugs, such as ethambutol, isoniazid, rifampicin, streptomycin, and p‐amino salicylic acid, but also with antimycotics, such as fluconazole and itraconazole, as well as virostatics (amprenavir, efavirenz, nevirapine, zidovudine) . Other medications such as pentamidine and pyrimethamine were used in protozoal infections.…”

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

190

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

190

173

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“…The reaction included maculopapular rash, blistering and erythematous lesion, fever, leukocytoclastic vasculitis, and toxic epidermolysis [58, 59]. …”

Section: Antiretroviral Drug Hypersensitivitymentioning

confidence: 99%

Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management

Yunihastuti

Widhani

Karjadi

2014

Asia Pacific Allergy

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Human immunodeficiency virus (HIV)-infected patients present complex immunological alterations. Multiple drugs that usually prescribed for prevention or treatment of opportunistic infections and antiretroviral pose these patients a higher risk of developing drug hypersensitivity. All antiretroviral agents and drugs to treat opportunistic infections have been reported to cause drug hypersensitivity reactions. Allergic reactions with antiretroviral are not restricted to older agents, although newer drugs usually more tolerated. Cutaneous adverse drug reactions are the most common manifestation of drug hypersensitivity in HIV, typically manifesting as maculopapular rash with or without systemic symptoms in the presence or absence of internal organ involvement. The onset of an allergic reaction is usually delayed. Severe drug hypersensitity reactions as erythema multiforme, Stevens Johnson syndrome and toxic epidermal necrolysis develop more often in HIV-infected patients compared to other populations. Mild to moderate rash without systemic symptom or organ involvement usually do not need drug discontinuation. Appropriate diagnosis and management of drug hypersensitivity reactions are essential, especially in patients with very low CD4+ T-cell count and multiple opportunistic infections. Clinicians should aware of different half-life of each drug when decided to stop the drug. Knowledge of the metabolism, recognition of the risk factors, and the ability to suggest the probability of particular drug as causative are also important points. A step wise rechallenge test or desensitization with the offending drug might be a preferable action and more commonly used in managing drug hypersensitivity in HIV-infected patients. Desensitization protocols have been successfully done for several antiretroviral and opportunistic infection drugs.

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“…Ribavirin desensitization has been described to occur over a period of 4 to 5 weeks to achieve therapeutic doses of 800 to 1000 mg daily [166,167]. In addition, desensitization protocols have been described for many antiretrovirals (ARVs), including nevirapine (Figure 20A) [168,169], efavirenz (Figure 20B) [170], nelfinavir [171,172], darunavir [173], zidovudine [174], and enfuvirtide [152,175,176,177]. However, one of the most notorious ARV associated with an HSR is abacavir.…”

Section: Resultsmentioning

confidence: 99%

Antimicrobial Desensitization: A Review of Published Protocols

et al. 2019

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Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs that may otherwise cause hypersensitivity reactions. While no universal antimicrobial desensitization protocols exist, this review critically analyzes previously published desensitization protocols. The purpose of this review is to provide a greater insight for clinicians and institutions to ensure desensitization procedures are efficacious while minimizing potential for patient harm. With an increasing rate of antimicrobial resistance and the critical need to preserve antimicrobial agents, desensitization may represent another option in our antimicrobial stewardship toolkit.

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Zidovudine-related erythroderma and successful desensitization: A case report☆, ☆☆, ★

Cited by 22 publications

References 3 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

Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management

Antimicrobial Desensitization: A Review of Published Protocols

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