Insights in Allergy, Asthma and Bronchitis

Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the United States and affects over 11% of women over the age of 40 [1]. Metronidazole and tinidazole are the only medications that are recommended by the Centers for Disease Control for the treatment of trichomoniasis1. Alternative therapies are not standardized and limited in efficacy [2]. Case reports suggest that there is cross-reactivity between metronidazole and tinidazole [3]. The body of literature describing metronidazole hypersensitivity is scarce and to date, the incidence is unknown. Skin-prick testing to metronidazole is not validated. Three metronidazole desensitization protocols have been described, including one intravenous3 and two oral protocols [4,5]. In 2008, the Centers for Disease Control and Prevention published a study documenting a total of 127 patients with suspected metronidazole hypersensitivity, among whom 15 patients underwent metronidazole desensitization2. Among those 15 patients, 7 patients underwent a 14-dose intravenous protocol3 and 8 patients underwent an 8-dose oral protocol5. All 15 patients achieved infection cure. More recently, a 12dose modified oral desensitization protocol was described by Gendelman and colleagues in 2014.