Successful Rapid Desensitization with Nitrofurantoin in a Patient with Multiple Drug Allergy Syndrome.

BACKGROUND Drug-induced anaphylaxis is increasingly reported in children, and multiple drug allergy syndrome (MDAS) poses therapeutic challenges. Desensitization may be considered when no alternative therapy exists. Nitrofurantoin is widely used for uncomplicated urinary tract infections (UTIs); however, anaphylaxis related to it has been rarely described, and no cases of desensitization have been reported.

CASE PRESENTATION We present the case of an 8-year-old girl with recurrent UTIs and MDAS who had experienced anaphylaxis to amoxicillin and nitrofurantoin, as well as urticaria associated with aminoglycosides and cephalosporins. After isolation of Escherichia coli resistant to multiple antibiotics but sensitive to nitrofurantoin, a rapid 12-step oral desensitization protocol was implemented under close monitoring. The procedure was well tolerated without systemic reactions, and nitrofurantoin prophylaxis was successfully initiated.

CONCLUSIONS To the best of our knowledge, this is the first reported case of successful nitrofurantoin desensitization in a child with MDAS, providing a potential therapeutic option for similarly high-risk scenarios.