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Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.
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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Modified oral metronidazole desensitization protocol.

Samantha R Gendelman1, Lily C Pien, Ravi C Gutta

  • 1Department of Allergy and Immunology, Cleveland Clinic Foundation, Respiratory Institute, Cleveland, Ohio, USA.

Allergy & Rhinology (Providence, R.I.)
|March 12, 2014
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Summary
This summary is machine-generated.

This study introduces a new, gradual oral desensitization protocol for metronidazole, reducing systemic reactions in patients with trichomoniasis and hypersensitivity. The modified protocol offers a safer alternative for allergy management.

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Area of Science:

  • Allergy and Immunology
  • Infectious Diseases
  • Pharmacology

Background:

  • Metronidazole desensitization is recommended for trichomoniasis patients with hypersensitivity.
  • A single oral desensitization protocol exists, potentially causing systemic reactions.
  • There is a need for a more gradual protocol to minimize adverse events.

Purpose of the Study:

  • To design and evaluate a novel, more gradual oral metronidazole desensitization protocol.
  • To decrease the incidence and severity of systemic reactions during desensitization.
  • To provide an alternative desensitization option for patients with presumed IgE-mediated metronidazole allergy.

Main Methods:

  • Development of a modified, gradual oral metronidazole desensitization protocol.
  • Administration of the protocol to two patients with presumed IgE-mediated metronidazole allergy and trichomoniasis.
  • Monitoring for systemic reactions and adjusting the protocol as needed.

Main Results:

  • Patient 1 experienced mild systemic reactions (nasal congestion, pruritus) managed with antihistamines, completing desensitization at 250 mg every 6 hours due to GI irritation.
  • Patient 2 had transient lip tingling and pruritus after a 10-mg dose, resolved with fexofenadine, and tolerated the remainder of the protocol, receiving 2 g of metronidazole.
  • Both patients successfully underwent desensitization with the modified protocol, despite initial mild reactions.

Conclusions:

  • The modified oral metronidazole desensitization protocol is a viable option for managing presumed IgE-mediated reactions.
  • This protocol offers a more gradual approach, potentially reducing systemic side effects.
  • It provides a valuable alternative for clinicians treating patients with metronidazole hypersensitivity.