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Hypersensitivity reactions including IgE-mediated and delayed cell-mediated reactions to aminoglycosides, clindamycin, linezolid, and metronidazole are rare.
Furthermore, patients should not receive desensitization if they had previous reactions manifesting as cutaneous or systemic vasculitis, extensive mucosal ulcers, iatrogenic autoimmune reactions, severe generalized symptoms such as fever, arthritis, systemic lymphadenopathy, severe eosinophilia, or if internal organs
Desensitization is indicated when a patient has a clear history of a type I allergy and there are no alternative antibiotic substitutions. It is indicated each time the patient is re-exposed to a course of the antibiotic.
To date, aspirin desensitization is employed with patients with nonsteroidal anti-inflammatory drugs (NSAIDs) exacerbated respiratory diseases (NERD) or with aspirin or NSAIDs hypersensitive patients needing a stent procedure for coronary artery disease.
Desensitization has been recommended for immunoglobulin E (IgE)-mediated immediate hypersensitivity; however, its indications have recently been expanded to include non-IgE-mediated, non-immunological, or delayed T cell-mediated reactions. Currently, the mechanism of desensitization is not fully understood.
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Desensitization is a procedure that alters the immune response to the drug and results in temporary tolerance, allowing the patient with a drug hypersensitivity reaction to receive an uninterrupted course of the medication safely.
Metronidazole can be administered i.v. or orally depending on its indication for use and severity of infection. Our oral metronidazole desensitization protocol offers a second option for physicians who wish to use a more gradual escalation in dose when there is no suitable alternative antibiotic.
Protocol for oral and intravenous desensitization to penicillin usually starts with 1/10.000 to 1/1.000 of the target dose, and doses have a two-folds increase at each step. Doses are administrated every 15-20 min, over the course of several hours, until the therapeutic dose is docHubed.