Allergic manifestations in AIDS

During the progression of HIV infection, patients demonstrate immune dysregulation, and may develop increasing levels of serum IgE and other markers of atopic disease. In particular, elevated IgE levels have been correlated with a poorer prognosis. Patients with HIV infection have a higher incidence of drug hypersensitivity, sinusitis, and skin test reactivity to aeroallergens, but the exact prevalence of atopic airways disease has been difficult to ascertain. Prevalence studies of allergic rhinitis, asthma, urticaria, and allergic eczema in HIV-infected patients are hard to interpret owing to methodological limitations. Allergic manifestations can affect patients at any stage of HIV infection, but may herald evolution to AIDS in late stages. Up to 70% of HIV-infected patients develop drug reactions, which complicates management of opportunistic infections, but desensitization has been successful for many drugs. There is some evidence suggesting that immunologic and/or toxic mechanisms may underlie the pathogenesis of the frequently occurring drug reactions. In vitro studies have shown that antigenic stimulation induces T-cell proliferation and facilitates HIV replication. Recent in vivo studies demonstrate transient increases in the HIV viral load with vaccination and raise concern about the possibility of hastening HIV disease progression with allergen immunotherapy.