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Sulfonamide desensitization in solid organ transplant recipients: A protocol‐driven approach during the index transplant hospitalization
Author(s) -
Pryor Joseph B.,
Olyaei Ali J.,
Kirsch Denise,
Strasfeld Lynne
Publication year - 2019
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13191
Subject(s) - medicine , desensitization (medicine) , index (typography) , solid organ , sulfonamide , organ transplantation , intensive care medicine , transplantation , world wide web , chemistry , receptor , stereochemistry , computer science
Trimethoprim‐sulfamethoxazole (TMP‐SMX) is the first‐line agent for Pneumocystis jiroveci pneumonia (PJP) prophylaxis for solid organ transplant (SOT) recipients because of its efficacy for this indication, extended antimicrobial coverage, and favorable cost. Reported sulfonamide allergy is not uncommon and often results in TMP‐SMX avoidance. Desensitization offers an efficacious and cost‐effective alternative to TMP‐SMX avoidance. Herein, we reviewed our experience with desensitization during the index transplant hospitalization among 52 SOT recipients with history of a non‐anaphylactic sulfonamide allergy. Of those enrolled in the desensitization protocol, 92% (48/52) completed the protocol, with nearly 80% (41/52) still on TMP‐SMX at 3 months without adverse reaction. Eleven patients discontinued TMP‐SMX (7 for allergic reactions and 4 for non‐allergic reasons) and switched to pentamidine. A cost savings of $575 per desensitization was calculated based on annual wholesale drug prices, for a total savings of $23 575. Additionally, the protocol did not delay discharge in any patient nor was it associated with any severe allergic reactions. These findings suggest TMP‐SMX desensitization is safe and effective in SOT recipients with a history of non‐anaphylactic, non‐life‐threatening sulfonamide hypersensitivity.