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      Anaphylaxis to Oral Trimethoprim-Sulfamethoxazole in a Child: A Case Report

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          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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          Trimethoprim-sulfamethoxazole revisited.

          John Zurlo, N Joshi, Robert Miller … (2003)
          During the past 3 decades, the combination of trimethoprim and sulfamethoxazole has occupied a central role in the treatment of various commonly encountered infections and has also been particularly useful for several specific clinical conditions. However, changing resistance patterns and the introduction of newer broad-spectrum antibiotics have led to the need to carefully redefine the appropriate use of this agent in clinical practice. While trimethoprim-sulfamethoxazole's traditional role as empirical therapy for several infections has been modified by increasing resistance, it remains a highly useful alternative to the new generation of expanded-spectrum agents if resistance patterns and other clinical variables are carefully considered. It also seems to have an increasing role as a cost-effective pathogen-directed therapy with the potential to decrease or delay development of resistance to newer antibiotics used for empirical treatment. In addition, trimethoprim-sulfamethoxazole continues to be the drug of choice for several clinical indications.
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            Drug Allergy: A 2022 Practice Parameter Update

            David Khan, Aleena Banerji, Kimberly Blumenthal … (2022)
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              Basophil activation test: Mechanisms and considerations for use in clinical trials and clinical practice

              Alexandra F Santos, Oral Alpan, Hans-Jürgen Hoffmann (2021)
              The basophil activation test (BAT) is a functional assay that measures the degree of degranulation following stimulation with allergen or controls by flow cytometry. It correlates directly with histamine release. From the dose-response curve resulting from BAT in allergic patients, basophil reactivity (%CD63+ basophils) and basophil sensitivity (EC50 or similar) are the main outcomes of the test. BAT takes into account all characteristics of IgE and allergen and thus can be more specific than sensitization tests in the diagnosis of allergic disease. BAT reduces the need for in vivo procedures, such as intradermal tests and allergen challenges, which can cause allergic reactions of unpredictable severity. As it closely reflects the patients' phenotype in most cases, it may be used to support the diagnosis of food, venom and drug allergies and chronic urticaria, to monitor the natural resolution of food allergies and to predict and monitor clinical the response to immunomodulatory treatments, such as allergen-specific immunotherapy and biologicals. Clinical application of BAT requires analytical validation, clinical validation, standardization of procedures and quality assurance to ensure reproducibility and reliability of results. Currently, efforts are ongoing to establish a platform that could be used by laboratories in Europe and in the USA for quality assurance and certification.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 19 February 2025
                Publication date (Electronic, collection): February 2025
                Volume: 17
                Issue: 2
                Electronic Location Identifier: e79317
                Affiliations
                [1 ] Division of Allergy, Tokyo Metropolitan Children's Medical Center, Fuchu, JPN
                [2 ] Department of Pediatrics, National Defense Medical College Hospital, Tokorozawa, JPN
                Author notes
                Article
                DOI: 10.7759/cureus.79317
                PMC ID: 11929147
                PubMed ID: 40125154
                SO-VID: f099e5e6-b5db-489f-8530-f8b1e6a99c5f
                Copyright © Copyright © 2025, Mabuchi et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 17 February 2025
                Categories
                Subject: Pediatrics
                Subject: Allergy/Immunology

                Keywords: basophil activation test,drug allergy,drug provocation test,pediatric drug hypersensitivity,trimethoprim-sulfamethoxazole (tmp-smx)
                Data availability:
                Keywords: basophil activation test, drug allergy, drug provocation test, pediatric drug hypersensitivity, trimethoprim-sulfamethoxazole (tmp-smx)

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