Grand Rounds

Allergy to Sulpha

Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056, India

Clinical Problem :
An 18 months old child presented with pulmonary TB and HIV disease. He had failure to thrive {height = 71 cm, weight = 7 kg} with delayed development and hepatosplenomegaly. He was started on TMP-SMX prophylaxis but developed urticaria and thus was stopped. His CD4 count was 30 percent.

How to give PCP prophylaxis to this child_?

Discussion :
Some people are allergic to sulfa and develop reactions such as an itchy red rash, sometimes with fever. In affected people, this usually occurs during the second week of taking the drug. In rare cases these reactions are extremely serious. Given the importance of Cotrimoxazole and the lack of an equally effective and widely available alternative, desensitization is an important component of managing HIV infection. It can be attempted two weeks after a non-severe {grade 3 or less} Cotrimoxazole reaction that has resulted in a temporary interruption of cotrimoxazole. Desensitization should not be attempted in individuals with a history of grade 4 reaction to previous Cotrimoxazole or other sulfa drugs. It is recommended to commence an antihistamine regimen of choice one day prior to starting the regimen and to continue daily until completing the dose escalation. On the first day of the regimen, the step 1 dose of Cotrimoxazole is given and subsequently increased one step each day. If a severe reaction occurs, the desensitization regimen is terminated. If a minor reaction occurs, repeat the same step for an additional day. If the reaction subsides, advance to the next step` if the reaction worsens, the desensitization regimen is terminated.

E-published: June 2011 Vol 8 Issue 6 Art No. 40

Correct Answers :  yes 100%
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