Anaphylactic reactions associated with trimethoprim

Clin Exp Allergy. 1998 Apr;28(4):510-2. doi: 10.1046/j.1365-2222.1998.00258.x.


Background: Anaphylactic reactions to cotrimoxazole are often ascribed to the sulphamethoxazole component of this antibacterial drug.

Objective: To determine whether the trimethoprim component can be the cause of an anaphylactic reaction.

Methods: An analysis was made of reports on anaphylaxis attributed to trimethoprim, as notified to the Drug Safety Unit of the Dutch Inspectorate for Health Care.

Results: In the period between September 1981 and November 1995, 13 such reports were received. Nine were classified as probable anaphylaxis. Of these, the causal relationship between exposure to trimethoprim and anaphylaxis was classified as definite in three reports, and as probable in the other six. The remaining four reports were classified as possible anaphylaxis. In one of these, the causal relationship was classified as definite, and in three as probable.

Conclusion: Although anaphylaxis due to trimethoprim seems to be rare, it may be more common than previously thought. Apparently, anaphylaxis to cotrimoxazole is not always caused by sulphamethoxazole.

MeSH terms

  • Adult
  • Aged
  • Anaphylaxis / chemically induced*
  • Anti-Infective Agents, Urinary / adverse effects*
  • Antibodies, Anti-Idiotypic / blood
  • Female
  • Gastrointestinal Diseases / chemically induced
  • Humans
  • Male
  • Middle Aged
  • Respiratory Tract Diseases / chemically induced
  • Skin Diseases / chemically induced
  • Time Factors
  • Trimethoprim / adverse effects*
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects


  • Anti-Infective Agents, Urinary
  • Antibodies, Anti-Idiotypic
  • anti-IgE antibodies
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Trimethoprim