Managing drug reactions to sulfonamides and other drugs in HIV infection: desensitization rather than rechallenge?

Drug reactions in patients with HIV infection, e.g. fever or rash, are a fr equently occurring clinical problem. These side effects particularly are ob served with sulfonamides; however, many other drugs have also shown to indu ce allergic reactions when given to patients with HIV infection. The produc tion of hydroxylamines has been put forward at one of the explanations for these high incidence of reactions on drugs. Since sulfonamides are the first choice of therapy for the treatment and pr ophylaxis of Pneumocystis carinii pneumonia, several strategies have been d eveloped to circumvent drug reactions. In general rechallenge or desensitiz ation are recommended in literature. This article; discusses the results an d risks of rechallenge and desensitization with sulfonamides or other drugs , as mentioned in the literature. Furthermore preliminary results of rechal lenge with a sulfonamide, which is not metabolized into hydroxylamines, are presented from the data in the literature its concluded that desensitizati on should be preferred to rechallenge.