SUCCESSFUL RESUMPTION OF TRIMETHOPRIM-SULFAMETHOXAZOLE
(TS) AFTER ORAL DESENSITIZATION IN PATIENTS WITH CHRONIC GRANULOMATOUS
DISEASE (CGD)
Kotera F, Hasui M, Tuji S, Yamamoto A, Taniuchi S, Kobayashi Y
Department of Pediatrics, Kansai Medical University, Osaka, Japan
Objective: The purpose of our
study is to present successful TS desensitization in patients with CGD who
were previously intolerant to TS because of adverse reactions. Patients:
The first patient was a 10-year old boy diagnosed at 1 year of age. TS had
been attempted 4 times so far, accompanied each time by some adverse
reactions: fever, rash, hepatic dysfunction and DIC at 1 year; fever 2
hours after the ingestion at 2 years and 2 months; fever 6 hours after the
ingestion of sulfamethoxazole only at 2 years and 4 months; and fever and
rash 6 hours after the ingestion of TS at 10 years. The second patient was
a 13-year old male diagnosed at 3 years of age. TS was initially given at 1
year of age, which was followed by generalized eruption and fever 2 days
after the ingestion. Since then TS had not been prescribed.
Methods: The protocol
consisted of starting an initial dose of 0.005g (trimethoprim: 0.4mg,
sulfamethoxazole: 2mg) and doubling it twice a day to a full dose of 1g
(trimethoprim: 80mg, sulfamethoxazole: 400mg) in 5 days.
Results: The first patient
developed fever on the third day and urticaria and rash on the 4th and 5th
days, which disappeared spontaneously. The second patient had no adverse
reactions. They have received the maintenance TS therapy for 8 and 11
months, respectively, without any other adverse reactions.
Conclusion: Oral desensitization
to TS is a safe and useful option in the management of CGD patients who
have had adverse reactions.