Document 0210
 DOCN  M95A0210
 TI    Rapid oral desensitization to trimethoprim-sulfamethoxazole (TMP-SMZ):
       use in prophylaxis for Pneumocystis carinii pneumonia in patients with
       AIDS who were previously intolerant to TMP-SMZ.
 DT    9510
 AU    Gluckstein D; Ruskin J; Department of Internal Medicine, Kaiser
       Permanente Medical; Center, Los Angeles, California 90027, USA.
 SO    Clin Infect Dis. 1995 Apr;20(4):849-53. Unique Identifier : AIDSLINE
       MED/95315386
 AB    Trimethoprim-sulfamethoxazole (TMP-SMZ) is the drug of choice as
       prophylaxis for Pneumocystis carinii pneumonia in patients with AIDS.
       However, adverse reactions ascribed to TMP-SMZ are common in such
       patients. We previously described a rapid method of oral TMP-SMZ
       desensitization in patients with AIDS and varying degrees of intolerance
       to the drug. To assess the feasibility, safety, and long-term clinical
       utility of our desensitization protocol, we retrospectively studied 22
       consecutive patients who underwent desensitization. Prior to the
       procedure each of the study subjects had exhibited moderate to severe
       reactions to TMP-SMZ. Desensitization was successfully completed in 19
       (86%) of the patients. The three patients for whom desensitization
       failed experienced chills and/or vomiting that resolved promptly with
       symptomatic therapy. One of the 19 patients was unavailable for
       long-term follow-up. Of the remaining 18 patients, three discontinued
       taking TMP-SMZ within 2 weeks of desensitization because of macular rash
       and fever. The other 15 (71%) of the evaluable patients tolerated both
       desensitization and subsequent prophylaxis and took TMP-SMZ for a mean
       of 14 months (in some cases, for as long as 41 months). None had P.
       carinii pneumonia while receiving TMP-SMZ. These results indicate that
       most patients who are presumed to be TMP-SMZ-intolerant can be rapidly
       desensitized with oral TMP-SMZ and subsequently receive the drug for
       protracted periods as effective prophylaxis for P. carinii pneumonia.
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS  Administration, Oral
       Adult  Anaphylaxis/*CHEMICALLY INDUCED  *Desensitization, Immunologic
       Female  Follow-Up Studies  Human  Male  Pneumonia, Pneumocystis
       carinii/COMPLICATIONS/*PREVENTION &  CONTROL  Retrospective Studies
       Time Factors  Trimethoprim-Sulfamethoxazole Combination/ADVERSE EFFECTS/
       *THERAPEUTIC USE  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).