Treatment Antimycobacterial Drugs
ÎAllergic drug reactions to antimycobacterial drugs present significant problems in implementing long-term treatment regimens and preventing drug resistance to Mycobacterium tuberculosis. (C)
Diabetes Medications
ÎThe advent of human recombinant insulin has greatly reduced the incidence of life-threatening allergic reactions to approximately 1%. (C)
ÎMetformin and sulfonylurea antidiabetic drugs rarely cause immune- mediated reactions, such as leukocytoclastic vasculitis, generalized arteritis, granulomatous hepatitis, and autoimmune pemphigus vulgaris. (C)
Cancer Chemotherapeutic Agents
ÎCancer chemotherapeutic agents, such as taxanes (paclitaxel, docetaxel), platinum compounds (cisplatin, carboplatin, oxaliplatin), and asparaginase, may cause severe immediate-type reactions, which may be either anaphylactic or anaphylactoid in nature. (C)
ÎFor some chemotherapeutics (primarily the platinum-based compounds), skin testing may assist in identifying allergic patients who are at increased risk for an allergic reaction and for confirming IgE-mediated sensitivity. (C)
ÎRapid induction of drug tolerance protocols are available for most chemotherapeutic agents that cause immediate-type reactions, but they are not uniformly successful. (C)
ÎMethotrexate can cause interstitial reactions in the lungs, which can progress to fibrosis if use of the drug is continued. (C)
HIV Medications
ÎPatients infected with HIV have an increased frequency of adverse reactions to a variety of drugs; the pathogenesis of these reactions is likely multifactorial. (C)
ÎThe most common ADR in HIV-positive patients who take trimethoprim-sulfamethoxazole (TMP-SMX) is a morbilliform and/or maculopapular eruption, often associated with fever that occurs after 7 to 12 days of therapy. (C)
ÎHIV-positive patients who have experienced typical delayed exanthematous reactions to TMP-SMX and who require treatment with the drug (eg, for Pneumocystis carinii pneumonia) may undergo one of several published TMP-SMX induction of drug tolerance protocols. (D) To increase the likelihood of success, carry out the selected protocol after waiting at least one month after the reaction. (D)
16
