The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

A Case of Anaphylaxis to Trimethoprim-Sulfamethoxazole

박트림에 의한 아나필락시스 1예

  • Kim, Sung-Moo (Department of Internal Medicine, Chungbuk National University College of Medicine, Medical Research Institute) ;
  • Kim, Kyung-Sook (Chungbuk National University College of Medicine, Medical Research Institute and Regional Pharmarcovigilance Center) ;
  • Kim, Mi-Kyung (Department of Internal Medicine, Chungbuk National University College of Medicine, Medical Research Institute)
  • 김성무 (충북대학교 의과대학 의학연구소 내과학교실) ;
  • 김경숙 (충북대학교 의과대학 의학연구소 지역약물감시센터) ;
  • 김미경 (충북대학교 의과대학 의학연구소 내과학교실)
  • Published : 2011.03.01
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Abstract

Bactrim consists of the sulfonamides trimethoprim and sulfamethoxazole. These induce relatively frequent adverse drug reactions, including allergic reactions ranging from urticaria to anaphylaxis. Either component can be the causative allergen, so it is necessary to determine which has caused an allergic reaction to prevent further allergy. We report the case of a 46-year-old male with chronic renal failure who experienced anaphylactic shock twice after ingesting trimethoprim-sulfamethoxazole, as was proven by the medical history and skin prick testing. Enzyme-linked immunoassays and enzyme-linked allergen inhibition assays for allergen-specific IgE antibody for the five components of Bactrim showed that sulfamethoxazole was the causative allergen.

내원 5년 전 우측 신장 이식술 시행 후 박트림을 복용하였던 만성신부전 환자가 최근 만성중이염으로 박트림을 복용 후 전신두드러기, 혈관부종과 저혈압을 경험하여, 치료 후 박트림을 복용하지 말라고 교육하였지만, 만성중이염이 지속되어 환자 스스로 박트림을 다시 복용하여 저혈압과 혈관부종, 전신 두드러기 등 증상이 재발하였다. 박트림으로 피부단자 검사를 시행하여 강양성반응이 나타나 박트림에 의한 아나 필락시스임을 확진하였으며 면역효소법과 면역효소억제능 검사 결과 박트림의 다섯 가지 구성성분 중 sulfamethoxazole이 원인 알레르겐임을 확인하였다.

Keywords

References

  1. 조영주. 약물 알레르기의 진단. 대한내과학회지 2009;76:282-290.
  2. Gleckman R, Blagg N, Joubert DW. Trimethoprim: mechanisms of action, antimicrobial activity, bacterial resistance, pharmacokinetics, adverse reactions and therapeutic indications. Pharmacotherapy 1981;1:14-20.
  3. Moreno Escobosa MC, Cruz Granados S, Moya Quesada MC, Amat López J. Enanthema and fixed drug eruption caused by trimethoprim. J Investig Allergol Clin Immunol 2009;19:249-250.
  4. Medina I, Mills J, Leoung G, et al. Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: a controlled trial of trimethoprim-sulfamethoxazole versus trimethoprimdapsone. N Engl J Med 1990;323:776-782. https://doi.org/10.1056/NEJM199009203231202
  5. Strom BL, Schinnar R, Apter AJ, et al. Absence of cross reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics. N Engl J Med 2003;349:1628-1635. https://doi.org/10.1056/NEJMoa022963
  6. 손지연, 이경애, 홍윤경, 류완희. 류마티스관절염 환자에서 Trimethoprim-Sulfamethoxazole 사용 중 발생한 혈전성 혈소판 감소자반증 1예. 대한류마티스학회지 2009;16:296-300.
  7. 박재근, 서의근, 조영심 등. 에리트로마이신에 의한 아나필락시스 1예. 대한내과학회지 2010;78:660-663.
  8. Slatore CG, Tilles SA. Sulfonamide hypersensitivity. Immunol Allergy Clin North Am 2004;24:477-490. https://doi.org/10.1016/j.iac.2004.03.011
  9. Thomas CF Jr, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004;350:2487-2498. https://doi.org/10.1056/NEJMra032588
  10. Smilack JD. Trimethoprim-sulfamethoxazole. Mayo Clin Proc 1999;74:730-734. https://doi.org/10.4065/74.7.730
  11. Knowles S, Shapiro L, Shear NH. Should celecoxib be contraindicated in patients who are allergic to sulfonamides? Revisiting the meeting of 'sulfa' allergy. Drug Saf 2001;24:239-247. https://doi.org/10.2165/00002018-200124040-00001