Efavirenz
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Hypersensitivity reaction managed with desensitisation: case report A 52-year-old woman experienced a severe hypersensitivity reaction while receiving efavirenz; she subsequently underwent successful desensitisation. The HIV-positive woman was receiving antiretroviral therapy consisting of efavirenz 600 mg/day [route not stated] with lamivudine and zidovudine. Nine days after initiating treatment, she developed a non-pruritic, generalised maculopapular rash that started from her neck and face, and then spread to other parts of her body. The woman received chlorphenamine in addition to the antiretroviral therapy, but the rash continued. A hypersensitivity reaction was suspected, and efavirenz was discontinued for 5 days. Her rash resolved. Efavirenz 600 mg/day was restarted, and 1 day later, she developed a generalised rash and severe pruritus. All antiretroviral drugs were discontinued, and she received dexamethasone and loratadine. Her rash recovered in 1 week, and lamivudine and zidovudine were restarted without incident. The woman subsequently underwent a rapid efavirenz desensitisation protocol. She received a starting dose of 1:20 000 efavirenz solution, and a 7-hour desensitisation protocol was performed successfully, during which she receiving efavirenz 0.03mg–600mg. Efavirenz was reintroduced to her drug regimen, and there were no signs of hypersensitivity at follow-up 6 weeks later. Author comment: "According to the Naranjo probability scale, an efavirenz hypersensitivity reaction was probable and, based on AIDS Clinical Trial Group adverse experience grading scales and Hartwig et al. definitions, the reaction was grade 3." Khalili H, et al. Efavirenz severe hypersensitivity reaction: Case report and rapid desensitization protocol development. Annals of Pharmacotherapy 46: e12, No. 5, May 2012. Available from: URL: http://dx.doi.org/10.1345/aph.1Q773 803073478 Iran
0114-9954/10/1410-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 14 Jul 2012 No. 1410
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