Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
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Successful rapid desensitization to trimethoprim-sulfamethoxazole-induced delayed hypersensitivity

Trimethoprim-sulfamethoxazole에 대해 지연성 과민반응을 보인 환자에서 성공적인 급속 탈감작 치료 사례 1예

  • Yoon, Doran (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Ahn, Hongkeun (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Se Yong (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Hwang, Seong Jun (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Park, Han-Ki (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kang, Hye-Ryun (Department of Internal Medicine, Seoul National University College of Medicine)
  • 윤도란 (서울대학교 의과대학 내과학교실) ;
  • 안홍근 (서울대학교 의과대학 내과학교실) ;
  • 김세용 (서울대학교 의과대학 내과학교실) ;
  • 황성준 (서울대학교 의과대학 내과학교실) ;
  • 박한기 (서울대학교 의과대학 내과학교실) ;
  • 강혜련 (서울대학교 의과대학 내과학교실)
  • Published : 20150000
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Abstract

Trimethoprim-sulfamethoxazole (TMP-SMX) is an antibiotic used for the treatment or prophylaxis of Pneumocystis pneumonia and other infectious conditions. Sulfonamide derivatives have been reported to cause delayed hypersensitivity reactions, resulting in switch to less effective second-line antibiotics. Although desensitization is traditionally known to be effective in patients with immediate hypersensitivity, it is also applied to the treatment of delayed hypersensitivity in recent years. A 66-year-old female who had a history of repeated TMP-SMX-induced delayed hypersensitivity presenting as whole body rashes needed to take prophylactic dose of TMP-SMX (80/400 mg daily) before initiation of chemotherapy for multiple myeloma. Intravenous rapid desensitization was performed by using a 11-step, 4-bottle protocol from 1:1,000 to 1:1 solution for 3 hours to reach the target dose for prophylaxis. After successful rapid desensitization of TMP-SMX, 1-month prophylaxis was completed without any complications until the patient recovered normal immunity. We herein reported a case of delayed hypersensitivity reaction to TMP-SMX in an about-to-be immunocompromised host with planned chemotherapy who successfully completed 1-month prophylaxis with the drug without any complications through rapid desensitization.

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Acknowledgement

This research was supported by a grant from Ministry of Food and Drug Safety to operation of the regional pharmacovigilance center in 2014.