final program.qxd - Parallels Plesk Panel

PP 4.25
Rapid Oral Desensitization to Abacavir in Case of Probable Hypersensitivity
Ulmer, Albrecht; Mueller, Markus; Frietsch, Bernhard
HIV-practice - Schwabstr. 26 - D-70197 Stuttgart, Germany
Objective
Symptoms of Abacavir (ABC) hypersensitivity syndrom (HSS) are not always clear and
sure. Initially in cases of doubt, later on, in probable cases, we tried to transfer a method
of rapid oral desensitization to trimethoprim-sulfamethoxazole, as published in 1995, to
ABC. The manufacturing company strictly recommends to discontinue taking ABC in such
cases. But then a precious substance is lost forever.
Methods
Of 360 patients treated with ABC, 15 (4,4%, 9 men, 6 women) reported HSS-probable
symptoms within the first 19 (mean 6,1) days: 10 x fever or feeling of having influenza,
1 x myalgia and arthralgia, 7 x nausea, 3 x stomach ache, 3 x diarrhoea, 5 x exanthema
(4x mild, 1 x fotodocumented) 4 x pharyngitis, 1 x trembling and 1 x dyspnoea. Mean CD4
was 420.1 (20 - 1030)/µl. All patients had antiretroviral pretreatment, and 14 of them,
parallel to the start with ABC, a prescription of 5 mg prednisolone daily.
In 5 cases, ABC was stopped at once. In 10 patients, we performed a sequence of
dilutions, beginning with 1 teaspoon of a solution of one tablet in 200ml water. The
dosage was doubled every 12 hours if the symptoms remained gone. The original
dosage was reached again within a few days, not later than after 1 week. Prednisolone
dose was raised to 10mg daily in the first days. Patients were asked to come daily for
checks.
Results
HSS-symptoms disappeared in 7 of the 10 patients within the first day and didn't reappear.
In all of these 7 patients ABC was tolerated well afterwards and in 6 patients effective
(continuous reduction of viral load (VL)