RAPID ORAL DESENSITIZATION FOR SULFONAMIDES IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Background: A prospective case series was undertaken in a university t eaching hospital. Objective: To evaluate the safety and efficacy of tw o oral desensitization procedures for sulfonamides in patients with th e acquired immunodeficiency syndrome (AIDS). Methods: A rapid oral des ensitization protocol to sulfadiazine (2.5 hours) or trimethoprim-sulf amethoxazole (8 hours) was used. Increasing volumes of either drug wer e given orally every 15 minutes until 1 g of sulfadiazine or 1443.3 mg of trimethoprim-sulfamethoxazole was reached. Results: Nine of 13 (69 %) patients were able to tolerate sulfadiazine for a period of 10 to 7 30 days (mean: 184 days). This was achieved in eight patients after th e first attempt, in one after the second attempt. Five patients failed after the first attempts with or without premedications. Two of these five failed despite two attempts. Two patients relapsed 21 days after responding to rapid desensitization. Three patients underwent a succe ssful 5 to 6-day slow desensitization protocol with premedications wit h high dose corticosteroids and antihistamines despite failures after two attempts with rapid desensitization in two of these patients and r elapse in one. Conclusions: Overall, 11 of 13 (85%) patients were succ essfully desensitized to sulfonamides using both rapid and slow method s. No life-threatening reactions occurred. Premedications with oral an tihistamines and corticosteroids may be needed to control and prevent early occurrences of rash or pruritus during desensitization. In those who fail rapid desensitization, the slow method with premedications i s an alternative.