Induction of tolerance in a patient with a history of exfoliative dermatitis to trimethoprim-sulfamethoxazole

摘要

Induction of drug tolerance can be considered in patients with immunogiobulin E (IgE)-mediated drug hypersensitivity when there are no acceptable alternative drugs. Induction of tolerance can also be considered in select non-IgE-mediated reactions. Protocols for induction of tolerance have been successful in human immunodeficiency virus (HlV)-positive patients with non-IgE-mediated mild cutaneous reactions to trimethoprim-sulfamethoxa-zole (TMP-SMX). In patients who are not HIV positive, the standard of care for drug-induced erythroderma is avoidance of the offending agent. Additionally, serious non-IgE mediated reactions such as exfoliative dermatitis or toxic epidermal necrolysis are considered a contraindication to graded drug challenge or induction of tolerance. We describe successful induction of tolerance in an HIV-negative patient with a history of exfoliative dermatitis to TMP-SMX.