Identification of mold on seasonal indoor coniferous trees.

thereby representing a novel time course for desensitization. Our starting dose was higher than the 0.02-mg starting dose administered to a non-HIV patient during fluconazole desensitization; however, our initial dose was equal to or less than other protocols involving HIV-infected patients.1,5,6 Given this patient’s HIV status, we used a cautious desensitization approach (eg, dose escalation every 6 hours) because of the evidence that HIV-infected individuals may experience possibly more severe drug-induced reactions, which may result from enhanced TH2-type responses in the setting of HIV.7,8 Within 2 days, the patient was able to tolerate the full, therapeutic dose of 200 mg twice per day of oral fluconazole. This protocol was completed without any adverse reactions. Premedication with diphenhydramine, 25 mg, and famotidine, 20 mg, was administered 30 minutes before starting desensitization. Diphenhydramine, 25 mg, was then given every 8 hours during the protocol, and famotidine was given every 12 hours. The patient was not taking systemic steroids before or during the desensitization. This premedication regimen was chosen because the patient was determined to have a high likelihood of drug-induced allergic reactions. This case demonstrates that a more rapid oral fluconazole desensitization may be possible in HIV-infected patients with a history of hypersensitivity to this medication. Further studies with more patients are needed to better characterize rapid desensitization protocols in patients with HIV/AIDS with fluconazole hypersensitivity.