Journal of Clinical Immunology

, Volume 11, Issue 2, pp 55–64 | Cite as

Allergic manifestations of human immunodeficiency virus (HIV) infection

  • Andrew Carr
  • David A. Cooper
  • Ronald Penny
Special Article

Abstract

Drug allergy is the most common and significant allergic manifestation of HIV3 infection. Initially described in patients treated with SMX-TMP for PCP, allergy is now known to involve a multitude of drugs. The pathogenesis of, and risk factors for, allergy in HIV infection are poorly understood, although there is evidence suggesting that allergy is more common with advancing immunodeficiency. HIV-negative subjects with sulfonamide allergy may have drug-specific antibodies and drug metabolite-induced lymphocyte cytotoxicity, abnormalities that could partly explain the allergic mechanisms and which may have future diagnostic potential; these abnormalities have not been described in HIV-infected subjects. Therapy includes avoidance, suppressive agents such as corticosteroids, and desensitization, although the appropriate role for each is not entirely clear. Serum IgE levels have been shown to rise with progressive disease; those patients with higher levels may have a worse prognosis. The mechanisms of this rise are multifactorial, probably a combination of altered T-lymphocyte regulation of IgE synthesis and of production of specific IgE directed against microbial antigens.

Key words

Drug hypersensitivity human immunodeficiency virus (HIV) IgE desensitization Pneumocystis carinii pneumonia 

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References

  1. 1.
    Mitsuyasu R, Groopman J, Volberding P: Cutaneous reaction to trimethoprim-sulphamethoxazole in patients with AIDS and Kaposi's sarcoma. N Engl J Med 308:1535–1536, 1983Google Scholar
  2. 2.
    Jaffe HS, Abrams DI, Ammann AJ, Lewis BJ, Golden JA: Complications of co-trimoxazole in treatment of AIDS-associatedPneumocystis carinii pneumonia in homosexual men. Lancet 1:1109–1111, 1983Google Scholar
  3. 3.
    Hughes WT, McNabb PC, Makres TD, Feldman S: Efficacy of trimethoprim and sulphamethoxazole in the prevention and treatment ofPneumocystis carinii pneumonitis. Antimicrob Agents Chemother 5:289–293, 1974Google Scholar
  4. 4.
    Hughes WT, Feldman S, Chandhary SC, Ossi MJ, Cox F, Sanyal SK: Comparison of pentamidine isethionate and trimethoprim-sulphamethoxazole in the treatment ofPneumøsystis carinii pneumonia. J Pediat 92:285–291, 1978Google Scholar
  5. 5.
    Kovacs JA, Hiementz JW, Macher AM, Stover D, Murray HW, Shelhamer J, Lane HC, Urmacher C, Honig C, Longo DL, Parker MM, Natanson C, Parrillo JE, Fauci AS, Pizzo PA, Masur H:Pneumocystis carinii pneumonia: A comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 100:663–671, 1984Google Scholar
  6. 6.
    Jick J: Adverse reactions to trimethoprim-sulphamethoxazole in hospitalized patients. Rev Infect Dis 4:426–428, 1982Google Scholar
  7. 7.
    Lau WK, Young LS: Trimethoprim-sulphamethoxazole treatment ofPneumocystis carinii pneumonia in adults. N Engl J Med 295:716–718, 1976Google Scholar
  8. 8.
    Winston DJ, Lau WK, Young LS: Trimethoprim-sulphamethoxazole for the treatment ofPneumocystis carinii pneumonia. Ann Intern Med 92:762–769, 1980Google Scholar
  9. 9.
    Gordin FM, Simon GL, Wofsy CB, Mills J: Adverse reactions to trimethoprim-sulphamethoxazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med 100:495–499, 1984Google Scholar
  10. 10.
    Sattler FR, Cowan R, Nielsen DM, Ruskin J: Trimethoprim-sulphamethoxazole compared with pentamidine for treatment ofPneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: A prospective noncrossover study. Ann Intern Med 109:280–287, 1988Google Scholar
  11. 11.
    Wharton JM, Coleman DL, Wofsy CB, Luce JM, Blumenfeld W, Hadley WK, Ingram-Drake L, Volberding PA, Hopewell PC: Trimethoprim-sulphamethoxazole or pentamidine forPneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Ann Intern Med 105:37–44, 1986Google Scholar
  12. 12.
    Murray JF, Garay SM, Hopewell PC, Mills J, Snider CL, Stover DE: NHLBI workshop summary. Pulmonary complications of the Acquired Immunodeficiency Syndrome: An update. Report of the 2nd National Heart, Lung and Blood Institute Workshop. Am Rev Resp Dis 135:504–509, 1987Google Scholar
  13. 13.
    Brenner M, Ognibene FP, Lack EE, Simmons JT, Suffredini AF, Lane HC, Fauci AS, Parrillo JE, Shelhamer JH: Prognostic factors and life expectancy of patients with the acquired immunodeficiency syndrome andPneumocystis carinii pneumonia. Am Rev Resp Dis 136:813–826, 1987Google Scholar
  14. 14.
    Shafer RW, Seitzmann PA, Tapper ML. Successful prophylaxis ofPneumocystis carinii pneumonia with trimethoprim-sulphamethoxazole in AIDS patients with previous allergic reactions. J AIDS 2:389–393, 1989Google Scholar
  15. 15.
    Fischl MA, Dickinson GM, La Voie L: Safety and efficacy of sulphamethoxazole and trimethoprim chemoprophylaxis forPneumocystis carinii pneumonia in AIDS. JAMA 259:1185–1189, 1988Google Scholar
  16. 16.
    Leoung GS, Mills J, Hopewell PC, Hughes W, Wofsy C: Dapsone-trimethoprim forPneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: A prospective, randomized trial. Ann Intern Med 105:45–48, 1986Google Scholar
  17. 17.
    Lee BL, Medina I, Benowitz NL, Jacob P, Wosy CB, Mills J: Dapsone, trimethoprim and sulphamethoxazole plasma levels during treatment of Pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome (AIDS): Evidence of drug interactions. Ann Intern Med 110:606–611, 1989Google Scholar
  18. 18.
    Medina I, Mills J, Leoung G, Hopewell PC, Lee B, Modin G, Benowitz N, Wofsy C: Oral therapy forPneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: A controlled trial of trimethoprim-sulphamethoxazole versus trimethoprim-dapsone. N Engl J Med 323:776–782, 1990Google Scholar
  19. 19.
    Centers for Disease Control: Recommendations for the prevention of malaria among travellers. Morbid Mortal Week Rep 39 (No. RR-3):1–10, 1990Google Scholar
  20. 20.
    Raviglione MC, Dinan WA, Pablos-Mendez A, Palagiano A, Sabatini MT: Fatal toxic epidermal necrolysis during prophylaxis with pyrimethamine and sulfadoxine in a human immunodeficiency virus-infected person. Arch Intern Med 148:2683–2685, 1988Google Scholar
  21. 21.
    Hardy WD, Wolfe PR, Gottlieb MS, Knight S, Mibtsuyasu R, Young LS: Long term followup of fansidar prophylaxis for Pneumocystis carinii pneumonia in patients with AIDS. 3rd International Conference on AIDS (Abs THP 232), June 1987Google Scholar
  22. 22.
    Madoff LC, Scavuzzo D, Roberts RB: Fansidar secondary prophylaxis of Pneumocystis carinii pneumonia in AIDS patients. Clin Res 34:524A, 1986Google Scholar
  23. 23.
    Greenberger PA, Patterson R: Management of drug allergy in patients with acquired immunodeficiency syndrome. J Allergy Clin Immunol 79:484–488, 1987Google Scholar
  24. 24.
    Allegra CJ, Chabner BA, Tuazon CU, Ogata-Arakaki D, Baird B, Drake JC, Masur H: Treatment ofPneumocystis carinii pneumonia with trimetrexate in acquired immunodeficiency syndrome (AIDS). Semin Oncol 15:46–49, 1988Google Scholar
  25. 25.
    Leport C, Raffi F, Matheron S, Katlama C, Regnier B, Saimot AG, Marche C, Vedrenne C, Vilde JL: Treatment of central nervous system toxoplasmosis with pyrimethamine-sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome. Am J Med 84:94–100, 1988Google Scholar
  26. 26.
    Cohn JA, McMeeking A, Cohen W, Jacobs J, Holzmann RS: Evaluation of the policy of empiric treatment of suspected Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome. Am J Med 86:521–527, 1989Google Scholar
  27. 27.
    Wanke C, Tuazon CU, Kovacs A, Dina T, Davis DO, Barton N, Katz D, Lunde M, Levy C, Conley FK: Toxoplasma encephalitis in patients with acquired immunodeficiency syndrome: Diagnosis and response to therapy. Am J Trop Med Hyg 36:509–516, 1987Google Scholar
  28. 28.
    Ackerman Z, Levy M: Hypersensitivity reactions to drugs in acquired immunodeficiency syndrome. Postgrad Med J 63:55–56, 1987Google Scholar
  29. 29.
    Battegay M, Opravil M, Wuthrich B, Luthy R: Rash with amoxicillin-clavulanate therapy in HIV-infected patients (letter). Lancet 2:1100, 1989Google Scholar
  30. 30.
    Hostettler C, Amundson D, O'Connor S: Phenytoin hypersensitivity with pulmonary involvement in a hemophiliac patient with human immunodeficiency virus infection. Drug Intell Clin Pharm 21:875–876, 1987Google Scholar
  31. 31.
    Ong ELC, Mandal BK: Multiple drug reactions in a patient with AIDS (letter). Lancet 1:976–977, 1989Google Scholar
  32. 32.
    Kotani S, Hirose S, Niiya K, Kubonishi I, Miyoshi I: Anaphylaxis to flucytosine in a patient with AIDS. JAMA 260:3275–3276, 1988Google Scholar
  33. 33.
    Jacobson MA, McGrath MS, Joseph P, Molaghan JB, Tadepalli S, Quinn R: Zidovudine-induced fever. J AIDS 2:382–388, 1989Google Scholar
  34. 34.
    Lee MH, Torres R: Zidovudine-induced leukocytoclastic vasculitis. 6th International Conference on AIDS, Abstr 2026, June 1990Google Scholar
  35. 35.
    Connolly KJ, Allan JD, Fitch H, Jackson-Pope L, McLaren C, Groopman J: A phase I study of 2′-3′-dideoxyinosine (ddI) administered orally twice daily to patients with AIDS or ARC and haematologic intolerance to azidothymidine (AZT). 6th International Conference on AIDS, Abstr SB473, June 1990Google Scholar
  36. 36.
    Schooley RT, Meirgan TC, Gaut P, Hirsch MS, Holodniy M, Flynn T, Liu S, Byington RE, Henochonowicz S, Gubish E, Spriggs D, Kufe D, Schindler J, Dawson A, Thomas D, Hanson DG, Letwin B, Liu T, Gulinello J, Kennedy S, Fisher R, Ho DD: Recombinant soluble CD4 therapy in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex: A phase I-II escalating dosage trial. Ann Intern Med 112:254–261, 1990Google Scholar
  37. 37.
    Arnold PA, Guglielmo BJ, Hollander H: Severe hypersensitivity reaction upon rechallenge with trimethoprim-sulphamethoxazole in a patient with AIDS. Drug Intell Clin Pharm 22:43–45, 1988Google Scholar
  38. 38.
    Silvestri RC, Jensen WA, Zibrak JD, Alexander RC, Rose RM: Pulmonary infiltrates and hypoxaemia in patients with the acquired immune deficiency syndrome re-exposed to trimethoprim-sulphamethoxazole. Am Rev Resp Dis 136:1003–1004, 1987Google Scholar
  39. 39.
    Montaner JS, Lawson LM, Levitt N, Belzberg A, Schechter MT, Ruedy J: Corticosteroids prevent early deterioration in patients with moderately severePneumocystis carinii pneumonia and the acquired immune deficiency syndrome (AIDS). Ann Intern Med 113:14–20, 1990Google Scholar
  40. 40.
    Gluckstein D, Ruskin J, Nielsen D: Oral desensitisation to trimethoprim-sulphamethoxazole in hypersensitive AIDS patients: Utility jin trimethoprim-sulphamethoxazole prophylaxis of Pneumocystis carinii pneumonia. 4th International Conference on AIDS A7176, June 1988Google Scholar
  41. 41.
    Finegold I: Oral desensitisation to trimethoprim-sulphamethoxazole in a patient with acquired immunodeficiency syndrome. J Allergy Clin Immunol 78:905–908, 1986Google Scholar
  42. 42.
    Bell ET, Tapper ML, Pollock AA: Sulphadiazine desensitisation in AIDS patients (letter). Lancet 1:163, 1985Google Scholar
  43. 43.
    Tenant-Flowers M, Boyle M, Carey D, Marriott D, Cooper DA, Penny R: Sulphadiazine desensitisation in patients with AIDS and cerebral toxoplasmosis. AIDS 1991 (in press)Google Scholar
  44. 44.
    Pullen H, Wright N, Murdoch JMcC: Hypersensitivity reactions to antibacterial drugs in infectious mononucleosis. Lancet 2:1176–1178, 1967Google Scholar
  45. 45.
    Klemola E: Hypersensitivity reactions to ampicillin in cytomegalovirus mononucleiosis. Scand J Infect Dis 2:29–31, 1970Google Scholar
  46. 46.
    Cameron SJ, Richmond J: Ampicillin hypersensitivity in lymphatic leukaemia. Scott Med J 16:425–427, 1971Google Scholar
  47. 47.
    Boston Collaborative Drug Surveillance Program: Excess of ampicillin rashes associated with allopurinol or hyperuricaemia. N Engl J Med 282:505–507, 1972Google Scholar
  48. 48.
    Shear NH, Spielberg SP, Grant DM, Tang BK, Kalow W: Differences in metabolism of sulfonamides predisposing to idiosyncratic toxicity. Ann Intern Med 105:179–184, 1986Google Scholar
  49. 49.
    Hughes WT, Rivera GK, Schell MJ, Thornton D, Lott L: Successful intermittent chemoprophylaxis ofPneumocystis carinii pneumonia. N Engl J Med 316:1627–1632, 1987Google Scholar
  50. 50.
    Cohn DL, Penley KA, Judson FN, Kirkpatrick CH, Horsburgh CR, Davis KC: The acquired immunodeficiency syndrome and a trimethoprim-sulphamethoxazole adverse reaction. Ann Intern Med 100:311, 1984Google Scholar
  51. 51.
    Rieder MJ, Uetrecht J, Shear NH, Cannon M, Miller M, Spielberg SP: Diagnosis of sulfonamide hypersensitivity reactions by in-vitro “rechallenge” with hydroxylamine metabolites. Ann Intern Med 110:286–289, 1989Google Scholar
  52. 52.
    Rieder MJ, Uetrecht J, Shear NH, Spielberg SP: Synthesis andin vitro toxicity of hydroxylamine metabolites of sulfonamides. J Pharmacol Exp Ther 244:724–728, 1988Google Scholar
  53. 53.
    Harle DG, Baldo BA, Wells JV: Drugs as allergens: Detection and combining site specificites of IgE antibodies to sulphamethoxazole. Mol Immunol 25:1347–1354, 1988Google Scholar
  54. 54.
    Harle DG, Baldo BA, Smal MA, Van Nunen SA: An immunoassay for the detection of IgE antibodies to trimethoprim in the sera of allergic patients. Clin Allergy 17:209–216, 1987Google Scholar
  55. 55.
    Wright DN, Nelson RP, Ledford DK, Fernandez-Caldas E, Trudeau WL, Lockey RF: Serum IgE and human immunodeficiency virus (HIV) infection. J Allergy Clin Immunol 85:445–452, 1990Google Scholar
  56. 56.
    Quirino T, Brugo MA, Coen M, Vigevani GM, Antoniazzi E, Milazzo F: Drug allergy, IgE, and immune complexes (I.C.) in HIV-infected patients. 4th International Conference on AIDS, A2121, June 1988Google Scholar
  57. 57.
    Tourani JM, Stern M, Lowenstein W, Israel-Biet D, Andrieu JM: Prognosis factors in a cohort of 250 HIV seropositive patients. 6th International Conference on AIDS, A3135, June 1990Google Scholar
  58. 58.
    Ring J, Kraus K, Froschl M, Burg G: AIDS, HIV infection and allergy (abstr). J Allergy Clin Immunol 81:216, 1988Google Scholar
  59. 59.
    Pedersen M, Nielsen CM, Permin H, Norn S: HIV antigen stimulates basophil leukocytes from AIDS patients to release histamine due to type I allergy. Agents Actions 27:55–57, 1989Google Scholar
  60. 60.
    Pedersen M, Permin H, Jensen C, Skov PS, Norn S, Faber V: Histamine release from basophil leukocytes induced by microbial antigen preparations in patients with AIDS. Allergy 42:291–297, 1987Google Scholar
  61. 61.
    Pedersen M, Nielsen PB, Permin H, Norn S, Mojon M, Skov PS, Faber V: Type I reactions directed againstPneumocystis carinii in AIDS patients. APMIS 97:120–124, 1989Google Scholar
  62. 62.
    Buckley RH, Fiscus SA: Serum IgD and IgE concentrations in immune deficiency diseases. J Clin Invest 55:157–165, 1975Google Scholar
  63. 63.
    Polmar SH, Waldmann TA, Terry WD: IgE in Immunodeficiency. Am J Pathol 69:499–512, 1972Google Scholar
  64. 64.
    Romagnani S, Biagiotti R, Amadori A, Maggi E, Biti G, Bellesi G, Ricci M: Hyperproduction of IgE and T-cell dysfunction in Hodgkin's disease. Int Arch Allergy Appl Immunol 63:64–72, 1980Google Scholar
  65. 65.
    Ringden O, Perrson U, Johansson SGO, Wilczek H, Gahrton G, Groth CG, Lundgren G, Lonnquist B, Moller E: Markedly elevated serum IgE levels following allogeneic and syngeneic bone marrow transplantation. Blood 61:1190–1195, 1983Google Scholar
  66. 66.
    Snapper CM, Finkelman FD, Paul WE: Differential regulation of IgG1 and IgE synthesis by interleukin 4. J Exp Med 167:183–196, 1988Google Scholar
  67. 67.
    Pene J, Rousset F, Briere F, Chretien I, Paliard X, Banchereau J,et al. IgE production by normal human B cells induced by alloreactive T cell clones is mediated by IL-4 and suppressed by IFN-γ. J Immunol 141:1218–1224, 1988Google Scholar
  68. 68.
    Romagnani S, Del Prete G, Maggi E, Parronchi P, Tiri A, Macchia D, Guidizi MG, Almerigogna F, Ricci M: Role of interleukins in induction and regulation of human IgE synthesis. Clin Immunol Immunopathol 50:S13-S23, 1989Google Scholar
  69. 69.
    Ishizaka K: IgE-binding factors and regulation of the IgE antibody response. Annu Rev Immunol 6:513–534, 1988.Google Scholar
  70. 70.
    Lin RY: Chronic diffuse dermatitis and hyper-IgE in HIV infection. Acta Derm Venereol (Stockh) 68:486–491, 1988Google Scholar
  71. 71.
    Parkin JM, Eales LJ, Galazka AR, Pinching AJ: Atopic manifestations in the acquired immune deficiency syndrome: Response to recombinant interferon gamma. Br Med J 294:1185–1186, 1987Google Scholar
  72. 72.
    Ring J, Froschl M, Brunner R, Braun-Falco O: LAV/HTLV-III infection and atopy: Serum IgE and specific IgE antibodies to environmental allergens. Acta Derm Venereol (Stockh) 66:530–532, 1986Google Scholar

Copyright information

© Plenum Publishing Corporation 1991

Authors and Affiliations

  • Andrew Carr
    • 1
  • David A. Cooper
    • 1
    • 2
  • Ronald Penny
    • 1
  1. 1.Centre for ImmunologySt. Vincent's Hospital, DarlinghurstSydneyAustralia
  2. 2.National Centre of HIV Epidemiology and Clinical ResearchUniversity of New South WalesSydneyAustralia

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