Primary prevention is the avoidance of the culprit drug and of closely related drugs. We found two RCTs about prevention of drug reactions (not specifically for TEN). In the first trial, the incidence of rash complicating the first few weeks of treatment with nevirapine was significantly diminished by adding corticosteroids
Is there any test to prove drug culpability?
(50 mg every other day) for 2 weeks, or by using a slowly escalating dose.42 The second RCT demonstrated a lower incidence of adverse reactions to sulfamethoxazole in the prevention of pneumocystosis in HIV-infected individuals by using a slowly escalating dose.43 These two RCTs were concerned only with primary prevention and did not include patients with previous drug reactions.
By contrast, desensitisation with low doses of culprit drug and progressive increases concern patients with a history of benign drug eruption. We found one RCT: HIV patients with history of reaction to trimethoprim-sulfamethoxazole were rechallenged with oral trimethoprim. If no reaction was seen (59 cases of 73), patients were randomised to sulfamethoxazole with either a treatment scheme of desensitisation, or immediately at the dosage commonly used in prophylaxis. Adverse effects occurred in 28% of patients in the desensitisation group compared with 20-5% in the other group. This difference was not statistically significant.44
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