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Anaphylaxis to Oral Trimethoprim-Sulfamethoxazole in a Child: A Case Report
Haruna Mabuchi1,2, Naoki Kajita1, Go Kusakawa1
1Division of Allergy, Tokyo Metropolitan Children's Medical Center, Fuchu, JPN.
Insights
Anaphylaxis to trimethoprim-sulfamethoxazole (TMP-SMX) is rare but possible in children. A basophil activation test (BAT) showed promise as a safer diagnostic tool than drug provocation tests (DPT) for TMP-SMX allergy.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pharmacology
- Drug Hypersensitivity
Background:
- Trimethoprim-sulfamethoxazole (TMP-SMX) is a widely used antibiotic in pediatric care for treating infections and prophylaxis.
- While typically associated with non-immediate hypersensitivity, immediate reactions like anaphylaxis are uncommon.
Observation:
- A case report describes a 6-year-old girl who experienced anaphylaxis following TMP-SMX administration.
- Standard skin prick testing with TMP-SMX yielded negative results.
- The patient developed anaphylaxis during a drug provocation test (DPT).
Findings:
- A basophil activation test (BAT) performed on the patient for the TMP-SMX combination was positive.
- This suggests BAT may be a viable diagnostic method for TMP-SMX allergy.
- The positive BAT contrasts with the negative skin prick test, highlighting potential diagnostic limitations of traditional methods.
Implications:
- This case highlights the importance of considering alternative diagnostic strategies for drug hypersensitivity when conventional tests are inconclusive or high-risk.
- Basophil activation testing (BAT) may offer a safer and more sensitive approach for diagnosing TMP-SMX allergy in pediatric patients.
- Further research is warranted to validate the utility and reliability of BAT for TMP-SMX allergy diagnosis in broader populations.
Abstract:
Trimethoprim-sulfamethoxazole (TMP-SMX) is a non-β-lactam antibiotic commonly used in pediatrics to treat infections and as a prophylactic medication. Hypersensitivity to TMP-SMX is generally non-immediate, and immediate allergic reactions, including anaphylaxis, are rare. This case report details a six-year-old girl who experienced anaphylaxis to TMP-SMX. Her skin prick test with TMP-SMX was negative, but she developed anaphylaxis in a drug provocation test (DPT). An additional basophil activation test (BAT) for the TMP-SMX combination tablet was evaluated and was confirmed positive. This case underscores the need for alternative diagnostic methods like BAT, which pose a lower risk than DPT. The findings suggest that BAT could offer a safer diagnostic approach, though more studies are required to validate its use for TMP-SMX allergy diagnosis.
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