title: Successful outpatient graded administration of trimethoprim-sulfamethoxazole in patients without HIV and with a history of sulfonamide adverse drug reaction.
abstract: BACKGROUND
  The outcomes of trimethoprim-sulfamethoxazole (TMP-SMX) desensitization have been widely reported in the HIV literature but less so in the non-HIV literature.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of graded administration of TMP-SMX in patients without HIV and with a history of TMP-SMX adverse drug reaction (ADR).
  
  
  METHODS
  A retrospective chart review, 2004-2012, of all the patients without HIV seen in the Division of Allergic Diseases and with a history of TMP-SMX ADR who underwent outpatient graded administration of TMP-SMX was conducted. The medical record was reviewed for age, sex, details of the initial ADR to TMP-SMX, an indication for TMP-SMX administration, and outcome. Patients also were contacted by telephone, and medical records were reviewed to determine long-term outcomes.
  
  
  RESULTS
  Seventy-two patients (46 women [64%]; mean [SD] age, 57.7 ± 13.89 years]) were included. The most common patient-reported reactions to TMP-SMX were rash 39 (54%), and hives 9 (13%). TMP-SMX administration was needed for the following indications: prophylaxis (62 [86%]) and treatment of infection (10 [14%]). Forty-three of the patients (60%) underwent a 1-day TMP-SMX administration protocol. Thirty-five of the 43 (81%) underwent a 6-step (90 minutes to 6 hours) protocol and 7 of the 43 (16%) underwent a novel 14-step TMP-SMX protocol. Twenty-nine (40%) underwent a >1-day TMP-SMX administration protocol. Our overall success rate was 90% (mean duration of 11 months). Ninety-eight percent of the patients successfully completed a 1-day graded administration protocol, and 76% successfully completed a >1-day protocol. TMP-SMX was stopped in 8 patients because of the ADR.
  
  
  CONCLUSIONS
  We report the largest case series of successful outpatient graded administration of TMP-SMX with both 1-day and >1-day protocols, which have shown to be safe and well tolerated in patients without HIV and with a history of sulfonamide ADR.
authors.affiliation: Division of Allergic Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Regan C
authors.initials: RC
authors.lastname: Pyle
authors.affiliation: Division of Allergic Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Butterfield
authors.affiliation: Division of Allergic Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Volcheck
authors.affiliation: Division of Allergic Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Jenna C
authors.initials: JC
authors.lastname: Podjasek
authors.affiliation: Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Rank
authors.affiliation: Division of Allergic Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: James T C
authors.initials: JT
authors.lastname: Li
authors.affiliation: Allergy Associates of New Hampshire, Portsmouth, NH.
authors.forename: Amitha
authors.initials: A
authors.lastname: Harish
authors.affiliation: Division of Allergic Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Poe
authors.affiliation: Division of Allergic Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn. Electronic address: park.miguel@mayo.edu.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000486:Allergy and Immunology; D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: ADR; Adverse drug reaction; Drug hypersensitivity; Drug intolerance; Graded challenge; Immunologic; Orally; PCP; PO; Pneumocystis carinii pneumonia; TMP-SMX; Trimethoprim-sulfamethoxazole