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Arik E, Keskin Ö, Albayrak S, Keskin M, Cesur M, Karaoglan M, Inal G, Yildirim A, Kucukosmanoglu E. Allergic reactions to enzyme replacement therapy in children with lysosomal storage diseases and their management. J Pediatr Endocrinol Metab 2024:jpem-2024-0249. [PMID: 39243118 DOI: 10.1515/jpem-2024-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVES Human recombinant enzyme replacement therapy, given to compensate for genetic enzyme deficiency in lysosomal storage diseases, delays the progression of the disease and improves the quality of life. However, enzyme replacement therapy may cause hypersensitivity reactions. Within the scope of this research, we aimed to elucidate the frequency and clinical features of hypersensitivity reactions against enzyme replacement therapy in children with lysosomal storage diseases and clarify the management of these reactions. METHODS Medical records of pediatric patients with lysosomal storage disease and receiving enzyme replacement therapy were retrospectively reviewed, and patients who experienced allergic reactions were included in the study. The demographic characteristics of the patients, their diagnosis, the responsible enzyme, the time at which the reaction started and at what dose, the signs and symptoms associated with the reaction, diagnostic tests, the management of the reaction, and the protocol applied for the maintenance of enzyme replacement therapy after the reaction were recorded. RESULTS Hypersensitivity reactions developed in 18 of 71 patients (25.3 %) who received enzyme replacement therapy. The most common cutaneous findings were observed. Anaphylaxis developed in 6 of 18 patients. Patients who experienced recurrent hypersensitivity reactions with premedication or a slower infusion rate, those with positive skin test results, and patients who developed anaphylaxis were given enzyme replacement therapy with desensitization. CONCLUSIONS HSR may develop during enzyme replacement therapy, which are vital in lysosomal storage diseases, and discontinuation of enzyme replacement therapy is a significant loss for patients with metabolic disorders. These reactions can be treated with premedication and long-term infusions, but some patients may require desensitization protocols for continued treatment.
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Affiliation(s)
- Elif Arik
- Faculty of Medicine, Department of Pediatric Allergy and Immunology, Gaziantep University, Gaziantep, Türkiye
| | - Özlem Keskin
- Faculty of Medicine, Department of Pediatric Allergy and Immunology, Gaziantep University, Gaziantep, Türkiye
| | - Serpil Albayrak
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Türkiye
| | - Mehmet Keskin
- Faculty of Medicine Department of Pediatric Endocrinology and Metabolism, Gaziantep University, Gaziantep, Türkiye
| | - Mahmut Cesur
- Faculty of Medicine, Department of Pediatric Allergy and Immunology, Gaziantep University, Gaziantep, Türkiye
| | - Murat Karaoglan
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Türkiye
| | - Gaye Inal
- Faculty of Medicine, Department of Pediatric Allergy and Immunology, Gaziantep University, Gaziantep, Türkiye
| | - Ahmet Yildirim
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Türkiye
| | - Ercan Kucukosmanoglu
- Faculty of Medicine, Department of Pediatric Allergy and Immunology, Gaziantep University, Gaziantep, Türkiye
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Yeşilkaya S, Aksu K, Vural Solak GT, Demir Ş, Topel M, Erçelebi DÇ, Koca Kalkan İ, Ateş H, Köycü Buhari G, Nazik Bahçecioğlu S. Rapid drug desensitization to taxanes: a descriptive study from Turkey. J Oncol Pharm Pract 2023:10781552231213318. [PMID: 37936390 DOI: 10.1177/10781552231213318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
AIM To present the characteristics of drug hypersensitivity reactions (DHRs) among taxane recipients with non-small cell lung carcinoma (NSCLC), and to describe the results of rapid drug desensitization (RDD). METHODS A retrospective cross-sectional study included 45 patients who were treated with taxane for NSCLC and were found to be hypersensitive to taxane. All patients were administered the standard 3-bag, 12-step RDD protocol following the development of DHR. RDD success was evaluated separately for each cycle, and successful RDD was defined as the completion of the cycle with application of 12 steps of the desensitization protocol and the absence of early and/or late reactions afterwards. RESULTS Among 45 patients hypersensitive to taxane 43 (95.6%) successfully received taxane cycles with desensitization. Failed RDD occurred in only 2 (4.4%) patients. The total number of desensitization cycles was 183, of which 181 (98.9%) were successful. The mean age of patients with successful desensitization was 59.42 ± 10.48 years and 37 (86.0%) of them were male. CONCLUSION RDD is a reliable procedure that enables effective administration and completion of first-line taxane treatments in taxane-sensitive patients.
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Affiliation(s)
- Selma Yeşilkaya
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Kurtuluş Aksu
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Gürgün Tuğçe Vural Solak
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Şenay Demir
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Musa Topel
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Dilek Çuhadar Erçelebi
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - İlkay Koca Kalkan
- Division of Immunology and Allergy, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Hale Ateş
- Division of Immunology and Allergy, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Gözde Köycü Buhari
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
| | - Sakine Nazik Bahçecioğlu
- Division of Immunology and Allergy, University of Health Sciences, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey
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Cerci P. Allergic to ChatGPT? Introducing a Desensitization Protocol to Embrace Artificial Intelligence. Int Arch Allergy Immunol 2023; 184:903-905. [PMID: 37557096 DOI: 10.1159/000531785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/29/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Pamir Cerci
- Division of Immunology and Allergy, Department of Internal Medicine/Eskisehir City Hospital, Eskisehir, Turkey
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Prewitt BS, Mendoza JC, Coop CA, Weiss S, Quinn JM. A Failure of Rapid Drug Desensitization. Mil Med 2023; 188:e421-e425. [PMID: 33748854 DOI: 10.1093/milmed/usab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 01/11/2023] Open
Abstract
We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxycycline allergy, shellfish allergy, and untreated latent syphilis presented to the emergency room for a posterior migraine with associated nausea, vomiting, photophobia, right-sided paresthesias, and "shaky" vision. He was diagnosed with neurosyphilis and underwent rapid drug desensitization with the goal to receive a continuous infusion of PCN G. The patient's hospital course was complicated by intermittent drug reactions consisting of tachycardia, rash, and dyspnea, followed by periods of being able to tolerate the infusion. After being able to tolerate the recommended dose of PCN infusion, the patient was discharged home to complete the course. However, he returned almost immediately after a recurrence of symptoms at home requiring the use of intramuscular epinephrine. Ultimately, the patient was transitioned to ceftriaxone and completed the infusion course as an inpatient because of continued intermittent recurrence of drug reaction symptoms.
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Affiliation(s)
- Benjamin S Prewitt
- Department of Internal Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, TX 78234, USA
| | - Jun C Mendoza
- Department of Allergy and Immunology, Wilford Hall Medical Center, 59th Medical Group, San Antonio, TX 78236, USA
| | - Christopher A Coop
- Department of Allergy and Immunology, Wilford Hall Medical Center, 59th Medical Group, San Antonio, TX 78236, USA
| | - Samuel Weiss
- Department of Allergy and Immunology, Wilford Hall Medical Center, 59th Medical Group, San Antonio, TX 78236, USA
| | - James M Quinn
- Department of Allergy and Immunology, Wilford Hall Medical Center, 59th Medical Group, San Antonio, TX 78236, USA
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Rodríguez-Alarcón A, Barceló-Vidal J, Echeverría-Esnal D, Sorli L, Güerri-Fernández R, Ramis Fernández SM, Benitez-Cano A, Sendra E, López Montesinos I, Membrilla-Fernández E, Ferrández O, Adalia R, Horcajada JP, Escolano F, Gómez-Zorrilla S, Grau S. Antibiotic desensitization as a potential tool in antimicrobial stewardship programs: retrospective data analysis and systematic literature review. Expert Rev Anti Infect Ther 2022; 20:1491-1500. [PMID: 36069242 DOI: 10.1080/14787210.2022.2122443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Antibiotic allergy labels (AAL) are related to worse therapeutic results. Strategies to improve the management of these patients, such as the implementation of antibiotic desensitization, are essential for Antimicrobial Stewardship Programs (ASP). The aim of our study is to evaluate the efficacy and safety of antibiotic desensitization procedures for the management of patients with AAL. METHODS A retrospective study from 2015 to 2022 was performed to describe all antibiotic desensitization conducted in our institution, within the framework of ASP. A systematic literature review using electronic databases, such as PubMed, was also done to identify studies describing antibiotic desensitization between 2000 and 2022. RESULTS Sixteen antibiotic desensitization protocols were carried out in our institution. In fourteen cases, the desensitization was successfully completed, and the antibiotic could be used to treat the infection. In the systematic review, twenty-two studies were included, with a total of 202 desensitization episodes . In 97% of them, the desensitization was completed successfully. No desensitization-related mortality was observed neither in our cohort nor in literature review. CONCLUSIONS Antibiotic desensitization strategies should be considered a safe and effective tool that can be included in ASP for patients with a high risk of or confirmed allergy to penicillin.
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Affiliation(s)
- Alicia Rodríguez-Alarcón
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Jaime Barceló-Vidal
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Daniel Echeverría-Esnal
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Luisa Sorli
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Güerri-Fernández
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sofía Martina Ramis Fernández
- Pediatrics Service, Hospital del Mar de Barcelona. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Adela Benitez-Cano
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Inmaculada López Montesinos
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Estela Membrilla-Fernández
- Surgery Service, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Fabra, Barcelona, Spain
| | - Olivia Ferrández
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Ramón Adalia
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Escolano
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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McRae AS, Tidwell WP, Patel S, Lombard FW. Heparin desensitisation prior to cardiopulmonary bypass in a patient with alpha-gal allergy. Anaesth Rep 2022; 10:e12203. [PMID: 36561536 PMCID: PMC9758002 DOI: 10.1002/anr3.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
This case report describes the implementation of a heparin desensitisation strategy for a patient with confirmed galactose-alpha-1,3-galactose (alpha-gal) allergy, prior to cardiac surgery. We describe the pre-, intra- and postoperative management. We believe this report can enhance the limited data currently in existence on alternative strategies for heparin utilisation in cardiopulmonary bypass in a previously intolerant patient population.
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Affiliation(s)
- A. S. McRae
- Department of PharmacyVanderbilt University Medical CenterNashvilleTNUSA
| | - W. P. Tidwell
- Department of PharmacyVanderbilt University Medical CenterNashvilleTNUSA
| | - S. Patel
- Department of PharmacyAscension Saint Thomas Rutherford HospitalMurfreesboroTNUSA
| | - F. W. Lombard
- Department of AnesthesiaVanderbilt University Medical CenterNashvilleTNUSA
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Esenboga S, Akarsu A, Ocak M, Gur Cetinkaya P, Sahiner UM, Sekerel BE, Soyer O. Safety and efficacy of rapid drug desensitization in children. Pediatr Allergy Immunol 2022; 33:e13759. [PMID: 35338724 DOI: 10.1111/pai.13759] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Any drug taken at the recommended dosage may cause hypersensitivity reactions (DHR). Rapid drug desensitization (RDD) protocols have been developed in the case of a confirmed or highly suspected HSR to allow safe administration of the medicine when there is no alternative drug or in the presence of a less effective or more toxic alternative. The aim of this study was to evaluate the characteristics of children who underwent desensitization, the safety and efficacy of RDD in children, as well as, the characteristics and management of breakthrough reactions. METHOD This retrospective study concerned children who underwent RDD due to physician-diagnosed HSRs during or up to 48 hours after the infusion of various drugs between February 2010-February 2021. Patients with a chronic disease needing chronic drug usage and acute infections seen in patients with chronic diseases were included. The results of RDD were documented. RESULTS The study included 48 patients [8.1(IQR = 3.32-13.4) years, 60.4% male] with 58 HSRs of which 62.1% were classified as moderate and 5.2% as severe. Most of the patients were being treated for leukemia (41.7%), solid tumors (29.2%), and infections (6.3%). Skin tests were done for 41 out of 58 HSRs in 35 patients, and twenty of them were positive. A total of 269 RDDs were performed for 18 different drugs. Ninety percent of desensitizations were achieved with no reaction, and 3.7% and 5.6% with mild and moderate reactions, respectively. In multivariate analysis, skin test positivity was the only risk factor for breakthrough reactions (OR = 8.5, CI = 1.72-42.15, p = .009). CONCLUSION We demonstrated the safety and efficacy of RDD in childhood, thereby offered the first line treatment options to children with chronic diseases with hypersensitivity reactions (HSRs).
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Affiliation(s)
- Saliha Esenboga
- Department of Pediatrics, Division of Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayşegul Akarsu
- Department of Pediatrics, Division of Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Melike Ocak
- Department of Pediatrics, Division of Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pınar Gur Cetinkaya
- Department of Pediatrics, Division of Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umit Murat Sahiner
- Department of Pediatrics, Division of Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bulent Enis Sekerel
- Department of Pediatrics, Division of Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozge Soyer
- Department of Pediatrics, Division of Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Burke MJ, Zalewska-Szewczyk B. Hypersensitivity reactions to asparaginase therapy in acute lymphoblastic leukemia: immunology and clinical consequences. Future Oncol 2022; 18:1285-1299. [PMID: 35107320 DOI: 10.2217/fon-2021-1288] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Asparaginase is commonly used in combination therapy of acute lymphoblastic leukemia. However, as an immunogenic protein, hypersensitivity reactions (HSRs) during asparaginase therapy are frequent, indicating the development of anti-asparaginase antibodies. These can be associated with diminished clinical effectiveness, including poorer survival. Therapeutic drug monitoring of serum asparaginase activity to confirm complete asparagine depletion is therefore crucial during asparaginase therapy. Switching to alternative types of asparaginase is recommended for patients experiencing HSRs or silent inactivation; those with HSRs or silent inactivation on Escherichia coli-derived asparaginases should switch to another preparation. However, prior global shortages of Erwinia asparaginase highlight the importance of alternative non-E. coli-derived asparaginase, including recombinant Erwinia asparaginase.
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Affiliation(s)
- Michael J Burke
- Department of Pediatrics, Division of Pediatric Hematology-Oncology-Blood & Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Beata Zalewska-Szewczyk
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, 91-738, Lodz, Poland
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Rapid drug desensitization with platin-based chemotherapy: Analysis of risk factors for breakthrough reactions. World Allergy Organ J 2022; 15:100619. [PMID: 34992710 PMCID: PMC8703063 DOI: 10.1016/j.waojou.2021.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background All platin-based chemotherapeutics can cause hypersensitivity reactions (HSRs). With rapid drug desensitization (RDD), few patients experience breakthrough reactions (BTR) during desensitization. However, data about risk factors for BTRs during RDD in patients with HSRs to platins are limited. We first aimed to describe characteristics of our platin-reactive population and to validate the Brigham and Women's Hospital's (BWH's) RDD protocol in our population along with their outcomes with RDD. Our second aim was to identify the risk factors for BTRs. Method This was a retrospective chart review (2013–2020) of patients with symptoms of immediate HSRs to platins. Initial HSRs were classified as grade 1, 2, or 3 based on their severity. Skin prick tests (SPT)/intradermal tests (IDT) were performed with implicated platins. A 12-step protocol was used during RDD. Results The study comprised 65 women and seven men (mean age 57.78 ± 8.73 years). Initial HSRs to carboplatin, cisplatin, and oxaliplatin occurred in 38, 13, and 21 patients, respectively. All patients reacted at the fifth (median) recurrent infusions (min:1, max:20). The median values for carboplatin, cisplatin, and oxaliplatin were 6 (1–20), 3 (1–15), and 3 (1–11), respectively. Most initial HSRs were grade 2 (n = 40, 55.6%) and 3 (n = 27, 37.5%); only 6.9% (n = 5) were grade 1. Patients with grade 1, 2, and 3 initial HSRs had positive platin skin test results at rates of 80%, 74%, and 88%, respectively. A total of 232 RDDs were performed in 72 patients and 98.7% of these desensitizations were completed. BTRs occurred in 56 (24.1%) (grade 1 n = 14, 25%; grade 2 n = 32, 57%; grade 3 n = 10, 18%) of these desensitizations. Breakthrough reactions were more severe in patients with positive SPTs or 1:100 or 1:10 dilutions of IDT (p = 0.014). BTR was not observed during RDD in any of the patients with positive 1:1 dilutions of IDT. Positivity on prick or 1:100 or 1:10 IDT increased the risk of BTR 5.058 times. There was no significant association between the risk of BTRs and age, drug cycle, sex, comorbidities, or atopy. Conclusion In our experience, 98.7% of 232 RDDs to platins were completed successfully, showing that RDD was safe and effective. Drug skin test positivity is a potential marker for identifying high-risk patients who will have BTRs during RDDs to platins.
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10
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Alonso S, Segal NH, Cercek A, Yaeger R, Stadler Z, Kemeny N, Nusrat M, Shahrokni A, Connell L, Saltz LB. Simplified Graded Infusion Strategy for Mitigation of Oxaliplatin Hypersensitivity. Clin Colorectal Cancer 2022; 21:149-153. [DOI: 10.1016/j.clcc.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
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González-García R, Albanell-Fernández M, Aranda L, Gelis S, Bartra J, Soy Muner D, López-Cabezas C. Evaluation of desensitization protocols to betalactam antibiotics. J Clin Pharm Ther 2021; 47:592-599. [PMID: 34820864 DOI: 10.1111/jcpt.13578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Betalactam antibiotics are the most frequent cause of hypersensitivity reactions. Rapid drug desensitization (RDD) is a technique that induces temporary tolerance to a drug allowing a patient to receive the optimal agent. The increased use of RDD and the lack of standardization among available protocols in terms of formulation, starting dose, number of steps and dosing frequency make it essential to determine the safety and appropriate management of these protocols, especially regarding reconstitution, diluents, stability and drug administration in order to guarantee reproducibility. We reviewed betalactam desensitization protocols in a tertiary hospital, in accordance with currently published practices and evaluated its use on patients over a period of three years. METHODS (a) We performed a literature search in PubMed, MEDLINE and Google Scholar databases for case reports and/or systematic reviews describing desensitization protocols for betalactam antibiotics. Pharmacokinetic parameters and physicochemical stability were checked for each antibiotic. (b) We retrospectively reviewed inpatients undergoing our antibiotic desensitization protocols from February 2018 to January 2021. Data and outcomes of desensitization procedures were analysed. RESULTS We developed nine RDD protocols: meropenem, ceftriaxone, ceftazidime, ampicillin, ceftolozane/tazobactam, cloxacillin, piperacillin/tazobactam, amoxicillin/clavulanate and penicillin G sodium. Five antibiotics have RDD protocols for two different doses, adjusted to patients with impaired renal function. Detailed data (diluent, total dose, volume, concentrations, duration and stability) of the protocol of each antibiotic used are provided. 28 desensitizations were performed in 17 patients, three of them with confirmed allergies by skin test. 26 out of 28 (92.9%) of them were successfully completed, including those three with positive skin results. The pathogens most frequently involved were E. faecalis and P. aeruginosa; both frequently associated with bacterial resistance. Meropenem, ceftriaxone and ceftazidime were the antibiotics most desensitized. 25 out of 26 (96.1%) procedures were successful in resolving the infection. WHAT IS NEW AND CONCLUSIONS Detailed information about compounding, dilution and stability is crucial to ensure safe and successful desensitization processes, as well as good coordination between the Allergy and Pharmacy departments. The increase in bacterial resistance to many of the commercially available antibiotics limits the therapeutic options for treating multidrug-resistant infections; in those situations, antibiotic desensitization may be a key therapeutic option. Although there is a broad consensus in limiting the use of RDD to patients with confirmed allergy, in usual clinical practice its application in those strongly suspected of having type I hypersensitivity is still observed. Our betalactam desensitization protocols have shown themselves to be safe and effective, as evidenced by data from the 17 patients on whom they have been tested.
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Affiliation(s)
- Rubén González-García
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marta Albanell-Fernández
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Aranda
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sonia Gelis
- Allergology Section, Pneumology Service, ICR. ARADYAL, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Joan Bartra
- Allergology Section, Pneumology Service, ICR. ARADYAL, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Dolors Soy Muner
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Carmen López-Cabezas
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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12
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Lenders M, Brand E. Mechanisms of Neutralizing Anti-drug Antibody Formation and Clinical Relevance on Therapeutic Efficacy of Enzyme Replacement Therapies in Fabry Disease. Drugs 2021; 81:1969-1981. [PMID: 34748189 PMCID: PMC8602155 DOI: 10.1007/s40265-021-01621-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by mutations in the α-galactosidase A (AGAL/GLA) gene. The lysosomal accumulation of the substrates globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3) results in progressive renal failure, cardiomyopathy associated with cardiac arrhythmia, and recurrent strokes, significantly limiting life expectancy in affected patients. Current treatment options for FD include recombinant enzyme-replacement therapies (ERTs) with intravenous agalsidase-α (0.2 mg/kg body weight) or agalsidase-β (1 mg/kg body weight) every 2 weeks, facilitating cellular Gb3 clearance and an overall improvement of disease burden. However, ERT can lead to infusion-associated reactions, as well as the formation of neutralizing anti-drug antibodies (ADAs) in ERT-treated males, leading to an attenuation of therapy efficacy and thus disease progression. In this narrative review, we provide a brief overview of the clinical picture of FD and diagnostic confirmation. The focus is on the biochemical and clinical significance of neutralizing ADAs as a humoral response to ERT. In addition, we provide an overview of different methods for ADA measurement and characterization, as well as potential therapeutic approaches to prevent or eliminate ADAs in affected patients, which is representative for other ERT-treated lysosomal storage diseases.
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Affiliation(s)
- Malte Lenders
- Department of Internal Medicine D, Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Eva Brand
- Department of Internal Medicine D, Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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13
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Cohen B, Tomer G, Gavrilova T. Successful Drug Desensitization to Ustekinumab in a Patient with Crohn's Disease. Case Rep Gastroenterol 2021; 15:657-661. [PMID: 34720823 PMCID: PMC8458924 DOI: 10.1159/000516318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023] Open
Abstract
Ustekinumab is a monoclonal antibody used as treatment for various inflammatory conditions. We present a pediatric patient with Crohn's disease who did not tolerate infliximab and was then changed to ustekinumab. He developed anaphylaxis to the medication after the second dose. A drug desensitization protocol was created by the allergy team leading to successful administration of both intravenous and then subcutaneous ustekinumab. As monoclonal agents become mainstays of therapy for inflammatory conditions, there are increased reports of allergic reactions. Prior reports and protocols of ustekinumab desensitization have not been reported. This case report highlights successful desensitization to ustekinumab as well as the importance of a multidisciplinary approach to addressing treatment needs of patients who develop life-threatening reactions to such medications.
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Affiliation(s)
- Barrie Cohen
- Division of Allergy and Immunology, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gitit Tomer
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tatyana Gavrilova
- Division of Allergy and Immunology, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Division of Allergy and Immunology, Department of Medicine and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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14
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Tsilimidos G, Horisberger A, Ribi C, Cairoli A, Stalder G. Successful Rapid Oral Desensitization to Ibrutinib in a Patient With Severe Immediate Hypersensitivity Reaction. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2021; 21:e745-e747. [PMID: 34158264 DOI: 10.1016/j.clml.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/16/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Gerasimos Tsilimidos
- Division and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne.
| | - Alice Horisberger
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Anne Cairoli
- Division and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne
| | - Gregoire Stalder
- Division and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne
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15
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Sala-Cunill A, Molina-Molina GJ, Verdesoto JT, Labrador-Horrillo M, Luengo O, Galvan-Blasco P, Guilarte M, Cardona V. One-Dilution Rapid Desensitization Protocol to Chemotherapeutic and Biological Agents: A Five-Year Experience. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4045-4054. [PMID: 34214705 DOI: 10.1016/j.jaip.2021.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rapid drug desensitization (RDD) becomes a crucial procedure to allow treatment continuation in patients who suffer drug hypersensitivity reactions (DHRs) to chemotherapeutic (CMT) and biological agents (BA). OBJECTIVE The aim of the study was to compare the efficacy and safety of a one-bag dilution protocol (1DP) with a conventional three-bag dilution protocol (3DP) for desensitization of patients with CMT or BA hypersensitivity. METHODS Retrospective analysis of patients with immediate DHRs to CMT or BA who underwent at least 1 RDD procedure in our department between 2014 and 2019 was performed. Demographical data, clinical history, skin tests, tryptase levels, and risk assessment were registered. The safety, tolerability, occurrence, and severity of breakthrough reactions (BTR) with 3DP and 1DP were compared. RESULTS After the allergy workup, 157 patients fulfilled criteria to undergo RDD (137 females, mean age: 60.44 ± 12.6 years). A total of 639 RDDs (543 CMT and 96 BA) were performed using 3DP in 205 (48 patients) and 1DP in 434 (109 patients). Almost all procedures (636) were completed successfully. No BTR occurred in the first RDD in 52% and 51% of the 3DP and 1DP, respectively. Most BTR were mild. Moderate-severe BTR occurred in 17% with 3DP and 9% with 1DP. There were no statistical differences between protocols regarding the rate and severity of BTR. CONCLUSIONS RDD with 1DP to CMT and BA has equivalent outcomes to a 3DP desensitization in a selected population of patients in terms of efficacy, tolerability, and safety. Moreover, 1DP reduces the time required for RDD and simplifies the logistics.
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Affiliation(s)
- Anna Sala-Cunill
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Medicine Department, Barcelona, Spain
| | - Gustavo-Jorge Molina-Molina
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona, Spain
| | - Jenny-Tatiana Verdesoto
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Moisés Labrador-Horrillo
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Medicine Department, Barcelona, Spain.
| | - Olga Luengo
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Medicine Department, Barcelona, Spain
| | - Paula Galvan-Blasco
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona, Spain
| | - Mar Guilarte
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Medicine Department, Barcelona, Spain
| | - Victoria Cardona
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; ARADyAL Research Network, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Vall d'Hebron Institut de Recerca (VHIR), Immunomediated Diseases and Innovative Therapies, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Medicine Department, Barcelona, Spain
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16
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Guyer A, Iammatteo M, Karagic M, Macy E, Jerschow E. Tackling the Patient with Multiple Drug "Allergies": Multiple Drug Intolerance Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2870-2876. [PMID: 33039011 DOI: 10.1016/j.jaip.2020.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
As populations age, the prevalence of reported drug "allergy" increases, often leading to suboptimal care and increased morbidity because of unnecessary avoidance of safe and effective medications. Evaluation by a drug allergy specialist is often warranted when a patient has more than 2 unrelated drug "allergies" listed in the medical record. In this commentary, we clarify and propose standard terminology to use when evaluating patients with multiple drug allergy labels including and more specifically when diagnosing multiple drug intolerance syndrome and the much rarer multiple drug hypersensitivity syndrome. We review epidemiology and key features of multiple drug intolerance syndrome and multiple drug hypersensitivity syndrome. We summarize the methodologic and practical diagnostic workup and management of individuals with MDIS to assist with the accurate delabeling of drug "allergies" in the electronic health record.
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Affiliation(s)
- Autumn Guyer
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, Calif
| | | | - Merhunisa Karagic
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Eric Macy
- Southern California Permanente Medical Group, Allergy Department, Kaiser Permanente, San Diego, Calif
| | - Elina Jerschow
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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17
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Broyles AD, Banerji A, Barmettler S, Biggs CM, Blumenthal K, Brennan PJ, Breslow RG, Brockow K, Buchheit KM, Cahill KN, Cernadas J, Chiriac AM, Crestani E, Demoly P, Dewachter P, Dilley M, Farmer JR, Foer D, Fried AJ, Garon SL, Giannetti MP, Hepner DL, Hong DI, Hsu JT, Kothari PH, Kyin T, Lax T, Lee MJ, Lee-Sarwar K, Liu A, Logsdon S, Louisias M, MacGinnitie A, Maciag M, Minnicozzi S, Norton AE, Otani IM, Park M, Patil S, Phillips EJ, Picard M, Platt CD, Rachid R, Rodriguez T, Romano A, Stone CA, Torres MJ, Verdú M, Wang AL, Wickner P, Wolfson AR, Wong JT, Yee C, Zhou J, Castells M. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:S16-S116. [PMID: 33039007 DOI: 10.1016/j.jaip.2020.08.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ana Dioun Broyles
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Catherine M Biggs
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Rebecca G Breslow
- Division of Sports Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Josefina Cernadas
- Allergology and Immunology Service, Centro Hospitalar Universitário de S.João Hospital, Porto, Portugal
| | - Anca Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Elena Crestani
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Pascale Dewachter
- Department of Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meredith Dilley
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Ari J Fried
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarah L Garon
- Associated Allergists and Asthma Specialists, Chicago, Ill
| | - Matthew P Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David I Hong
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joyce T Hsu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Parul H Kothari
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Timothy Kyin
- Division of Asthma, Allergy & Immunology, University of Virginia, Charlottesville, Va
| | - Timothy Lax
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Min Jung Lee
- Allergy and Immunology at Hoag Medical Group, Newport Beach, Calif
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Anne Liu
- Division of Allergy / Immunology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stephanie Logsdon
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Andrew MacGinnitie
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Maciag
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Samantha Minnicozzi
- Division of Allergy and Clinical Immunology, Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Sarita Patil
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Division of Allergy and Clinical Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Tito Rodriguez
- Drug Allergy Department, Al-Rashed Allergy Center, Sulaibikhat, Al-Kuwait, Kuwait
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Maria Jose Torres
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
| | - Miriam Verdú
- Allergy Unit, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Alberta L Wang
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Johnson T Wong
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Joseph Zhou
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Mariana Castells
- Drug hypersensitivity and Desensitization Center, Brigham and Women's Hospital, Boston, Mass
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Sieber J, Renner S, Lakatos-Krepcik A, Szépfalusi Z. Case Report: Maintenance of Desensitization to Nebulized Colomycin Over 10 Years. Front Pediatr 2021; 9:663228. [PMID: 33869120 PMCID: PMC8049140 DOI: 10.3389/fped.2021.663228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/05/2021] [Indexed: 12/28/2022] Open
Abstract
Drug desensitization can be achieved successfully by gradual drug dose increases in different protocols. Most protocols are designed to obtain temporal tolerance. The data on long-term maintenance of drug tolerance is scarce. Based on an IgE-mediated colomycin allergy we describe the maintenance of drug tolerance to nebulized drug for the period of 10 years in a 15-year-old cystic fibrosis patient, proceeded by successful rush intravenous desensitization protocol. The mechanism of drug tolerance is largely speculative; however, long-term maintenance of it seems achievable by continuous local drug application.
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Affiliation(s)
- Justyna Sieber
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Departement of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria.,Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Sabine Renner
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Departement of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Zsolt Szépfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Departement of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
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19
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Mazhari A, Emanuele MA, Espiritu B. Desensitization to Methimazole. Endocr Pract 2020; 27:185-190. [PMID: 33779553 DOI: 10.1016/j.eprac.2020.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Thionamides (methimazole and propylthiouracil) have been associated with common side effects, such as rash and pruritus, and rare but serious adverse effects, such as agranulocytosis and hepatotoxicity. Methimazole is usually the preferred thionamide for the treatment of hyperthyroidism if the patient is not planning to conceive or not in the first trimester of pregnancy, given the less frequent dosing and lower risk of hepatotoxicity. In patients who experience rash or itching when treated with methimazole, switching them to propylthiouracil is one treatment option. Here we report our experience regarding desensitization to methimazole to allow continued treatment with methimazole as an alternative management option. METHODS We conducted a retrospective chart review of patients at a single institution who had side effects to methimazole and who were desensitized to methimazole under the supervision of an allergist. A total of 7 patients were included who experienced side effects to methimazole that did not include agranulocytosis or hepatotoxicity. RESULTS All 7 patients were able to take methimazole for treatment of their hyperthyroidism, either for continued medical therapy or as a bridge to definitive therapy, with either surgery or radioactive iodine treatment. CONCLUSION Under the supervision of an allergist, desensitization to methimazole is an option for treating patients who experience side effects to methimazole (excluding agranulocytosis and hepatotoxicity).
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20
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Di Girolamo A, Albanesi M, Loconte F, Di Bona D, Caiaffa MF, Macchia L. Desensitization in Iron Product Allergy. Acta Haematol 2020; 143:496-499. [PMID: 32182610 DOI: 10.1159/000503768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/29/2019] [Indexed: 11/19/2022]
Abstract
Iron deficiency is the main cause of anemia in both sexes, with women being more commonly affected. Iron therapy is currently considered an effective and safe remedy to replenish the iron storages. Iron can be administrated both orally and intravenously. In particular, intravenous (IV) iron therapy is widely used when oral iron preparations are either not tolerated or ineffective. Indeed, IV iron improves iron stores more rapidly. Two main immunological responses have been described for iron hypersensitivity reactions (HSRs): IgE-mediated allergy and complement activation-related pseudo-allergy. Here, we report 3 cases of adult patients with iron allergy, who were successfully treated with two different desensitization procedures, respectively. Analysis of these cases demonstrates that, in the presence of HSRs to iron products, desensitization is an effective and safe procedure that prevents treatment discontinuation and hence allows therapeutic target achievement.
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Affiliation(s)
- Attilio Di Girolamo
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari-Aldo Moro, Bari, Italy
| | - Marcello Albanesi
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari-Aldo Moro, Bari, Italy
| | - Filomena Loconte
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari-Aldo Moro, Bari, Italy
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari-Aldo Moro, Bari, Italy
| | - Maria Filomena Caiaffa
- Department of Medical and Surgical Sciences, School and Chair of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari-Aldo Moro, Bari, Italy,
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21
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Wachnian CJ, Baadjes B, Cheng S, Ramanzin A, Hildebrand KJ. Anaphylaxis to parenteral nutrition in a pediatric oncology patient treated with induction of drug tolerance protocol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:553-554. [PMID: 33096267 DOI: 10.1016/j.jaip.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cielle J Wachnian
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Bjorn Baadjes
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Cheng
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alyssa Ramanzin
- Nutrition Services, BC Children's Hospital, Vancouver, BC, Canada
| | - Kyla J Hildebrand
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Fouda GE, Bavbek S. Rituximab Hypersensitivity: From Clinical Presentation to Management. Front Pharmacol 2020; 11:572863. [PMID: 33013416 PMCID: PMC7508176 DOI: 10.3389/fphar.2020.572863] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022] Open
Abstract
Rituximab is a chimeric monoclonal antibody (mAb) against CD20 molecule which is expressed on human B cells. It has been used for the treatment of various lymphoid malignancies, lymphoproliferative diseases, and rheumatologic disorders. Rituximab is generally well tolerated. However, increased use of rituximab has been associated with hypersensitivity reactions (HSRs), which can be classified as infusion-related, cytokine-release, type I (IgE/non-IgE), mixed, type III, and type IV reactions. Immediate infusion-related reactions to rituximab are quite common and decrease in frequency with subsequent infusions. However, in about 10% of patients, severe infusion-related reactions develop, which prevent its use. Some of the immediate infusion reactions are due to a cytokine-release but some reactions raise concerns for type I (IgE/non-IgE) hypersensitivity. Recent studies have shown the presence of serum anti-rituximab antibodies, either represented by the IgG or IgE isotype. In some cases, clinical manifestations of IgE-mediated reactions and cytokine-release reactions partially overlap, which is called a mixed reaction. Classified as Type III reaction, rituximab-induced serum sickness reactions have been reported in patients with autoimmune diseases and hematological malignancies. The classic serum sickness triad (fever, rash, and arthralgia) has been observed in patients mainly with an underlying rheumatologic condition. Severe delayed type IV hypersensitivity reactions including non-severe maculopapular rash to severe reactions such as Stevens–Johnson syndrome and toxic epidermal necrolysis have been rarely reported following rituximab injection. Comprehensive reviews focused on rituximab-induced HSRs are scarce. We aimed to review clinical presentations, underlying mechanisms of rituximab hypersensitivity, as well as management including rapid drug desensitization.
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Affiliation(s)
- Ghada E Fouda
- Allergy and Immunology Center, Al-Azhar University, Cairo, Egypt
| | - Sevim Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
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Gülsen A, Wedi B, Jappe U. Hypersensitivity reactions to biologics (part II): classifications and current diagnostic and treatment approaches*. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-2567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Turgay Yagmur I, Unal Uzun O, Kucukcongar Yavas A, Kulhas Celik I, Toyran M, Gunduz M, Civelek E, Dibek Misirlioglu E. Management of hypersensitivity reactions to enzyme replacement therapy in children with lysosomal storage diseases. Ann Allergy Asthma Immunol 2020; 125:460-467. [PMID: 32687987 DOI: 10.1016/j.anai.2020.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/16/2020] [Accepted: 07/13/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intravenous recombinant enzyme replacement therapy (ERT) is currently available for 8 lysosomal diseases. Hypersensitivity reactions (HSRs) may be observed during this long-term treatment. OBJECTIVE To evaluate the frequency and clinical treatment features of ERT HSRs and the management of desensitizations in children. METHODS Medical records were reviewed retrospectively for patients who received ERT. Those who had experienced HSRs to ERT were included in the study. The demographic characteristics of the patients, culprit enzyme, signs and symptoms, diagnostic tests, management of the reaction, and the protocol employed for the maintenance of ERT were recorded. RESULTS During the study period, 54 patients received ERT in our institution. A total of 11 patients (20.4%) experienced HSR to ERT. All reactions were of immediate type. The most common symptoms were cutaneous manifestations. A total of 9 patients experienced urticaria, and 2 had anaphylaxis as initial reaction. Patients who had isolated cutaneous symptoms continued their treatments with antihistamines, corticosteroid premedication, slower infusion rate or both. Patients who had recurrent urticaria with these modalities or those who had anaphylaxis continued their ERT with desensitization (n = 8). A total of 3 patients required revisions in desensitization protocols because of recurrent anaphylaxis. CONCLUSION The reactions that develop during this long-term treatment may be treated by premedication-prolonged infusion, but in some patients, desensitization protocols are necessary for the continuation of therapy. Revisions in desensitization protocols may be required.
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Affiliation(s)
- Irem Turgay Yagmur
- Department of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey.
| | - Ozlem Unal Uzun
- Department of Pediatric Metabolic Disorders, Ankara City Hospital, Ankara, Turkey
| | | | - Ilknur Kulhas Celik
- Department of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey
| | - Muge Toyran
- Department of Pediatric Allergy and Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Gunduz
- Department of Pediatric Metabolic Disorders, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersoy Civelek
- Department of Pediatric Allergy and Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Emine Dibek Misirlioglu
- Department of Pediatric Allergy and Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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25
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Hypersensitivity reactions to biologics (part II): classifications and current diagnostic and treatment approaches. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40629-020-00127-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Purpose
Biotechnological substances (BS) have rapidly expanded their clinical use. In parallel, there is an increase in expected or unexpected immunological or non-immunological adverse effects. In this part of the review, the current nomenclature of BSs, the classification of hypersensitivity reactions (HSR), as well as diagnostic and treatment approaches are documented to provide the tools to understand the nomenclature used throughout the databases and the need to harmonize it where applicable.
Methods
Detailed searches were performed on Pubmed, Web of Science, and Google Scholar to include all available publications. The search terms, such as specific BS, allergy, anaphylaxis, hypersensitivity, reactions, classification, diagnosis, grading, management, and desensitization, were determined for the search. Case reports, articles, and reviews on this subject were included.
Results
Today, a variety of non-standardized methods are used to support the clinical diagnosis. These include prick-to-prick tests and intradermal tests with the drug itself and its potentially allergenic ingredients. More rarely, anti-drug antibodies are detected and basophil activation tests are used by centers with research facilities. Although the treatment protocols for acute conditions vary, the overall approach is the same.
Conclusion
HSRs to BS are gradually increasing with the widening of their clinical use and indications. It is very important to prevent HSRs and to know the degree of severity as well as the emergency treatment algorithm. This review summarizes the diagnostic tests that should be applied: (a) immediately during/after a reaction, and (b) subsequently, and in the case that a switch of BS is not possible, desensitization is an option.
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26
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Desensitization to biological agents used in rheumatology. Reumatologia 2020; 58:25-33. [PMID: 32322121 PMCID: PMC7174799 DOI: 10.5114/reum.2020.93510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Biological agents such as monoclonal antibodies and fusion proteins are widely used for the treatment of patients with various rheumatic disorders, influencing the quality of life, disability and even mortality in patients. However, biological agents can evoke adverse reactions of different grades of severity. Although drug avoidance remains a gold standard in the care of patients hypersensitive to medication, in certain clinical situations the culprit drug is the drug of choice and cannot be replaced by another equally effective compound. In such cases, desensitization can allow the patient to be treated within current guidelines and with the most effective treatment. The authors searched Medline and Scopus databases for English-language sources using the following key words: hypersensitivity, desensitization, biologicals, adalimumab, etanercept, adalimumab, certolizumab, golimumab, rituximab, infliximab, ixekizumab, tocilizumab, anakinra and canakinumab. The aim of our review is to present the current knowledge about desensitization to biological agents and some guidelines according to patient inclusion, contraindications, procedures, and safety requirements. Drug desensitization is a new issue in rheumatology, and the solution to the problem of allergic reactions to biological drugs, which gives patients with rheumatic diseases the opportunity to extend and prolong their therapy. The present article is one of the first widely discussing this topic in the biological treatment of rheumatic diseases.
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Chu DK, McCullagh DJ, Waserman S. Anaphylaxis for Internists: Definition, Evaluation, and Management, with a Focus on Commonly Encountered Problems. Med Clin North Am 2020; 104:25-44. [PMID: 31757236 DOI: 10.1016/j.mcna.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Anaphylaxis is an acute systemic allergic reaction that can be life threatening. In adults, the most common causes of anaphylaxis are foods, drugs, and insect stings. This article reviews the definition, classification, evaluation, differential diagnosis, prognosis, complications, and management of anaphylaxis. Tailored for internists, the article focuses on anaphylactic medication allergies. It provides a guide to optimally evaluate and manage patients with antibiotic allergy using a simple, rapid risk stratification technique, graded antibiotic challenge (test dose), and/or allergist-guided drug desensitization. It also reviews other causes of anaphylaxis that internists are likely to encounter, and an approach to their management.
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Affiliation(s)
- Derek K Chu
- Department of Medicine, McMaster University, 1200 Main Street West, HSC-3V49, Hamilton, Ontario L8N 3Z5, Canada.
| | - David J McCullagh
- Department of Medicine, McMaster University, 1200 Main Street West, HSC-3V49, Hamilton, Ontario L8N 3Z5, Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, 1200 Main Street West, HSC-3V49, Hamilton, Ontario L8N 3Z5, Canada.
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Babaie D, Shamsian BS, Momtazmanesh N, Godarzipour H, Amirmoini M, Bashardoust B, Ebrahimi M, Vahedi M, Ghaemi R, Mesdaghi M. Rapid Desensitization for Hypersensitivity Reactions to Chemotherapeutic Drugs; A Case Series. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2019; 18:1047-1051. [PMID: 31531085 PMCID: PMC6706720 DOI: 10.22037/ijpr.1999.1100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Usage of cancer chemotherapeutics drugs can be associated with adverse drug reactions. When IgE-mediated drug reactions are formed following administration of a chemotherapeutics drug that is a drug of choice, drug desensitization protocols can be helpful. HSR can be allergic or nonallergic, but the clinical manifestations are similar. RDD is effective when used appropriately, however it is often over utilized instead of performing a drug challenge. RDD is both an acceptable approach and a high-risk treatment modality in patients, in whom the offending agent is the first choice in chemotherapy. The safety of this modality has been acceptable in large studies. The side effects are often less frequent and less severe by repeating the protocol. We present 4 cases of successful desensitization in cancer patients, who have developed IgE- mediated reactions to their major chemotherapy drug.
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Affiliation(s)
- Delara Babaie
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bibi Shahin Shamsian
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Momtazmanesh
- Department of Pediatric Hematology and Oncology, Loghman-e- Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Godarzipour
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Amirmoini
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Bashardoust
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Ebrahimi
- Department of Pediatrics, Loghman-e- Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Vahedi
- Department of Pediatrics, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Ghaemi
- Department of Pediatrics, Urmia University of Medical Sciences, Urmia, Iran
| | - Mehrnaz Mesdaghi
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chastain DB, Hutzley VJ, Parekh J, Alegro JVG. Antimicrobial Desensitization: A Review of Published Protocols. PHARMACY 2019; 7:E112. [PMID: 31405062 PMCID: PMC6789802 DOI: 10.3390/pharmacy7030112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022] Open
Abstract
Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs that may otherwise cause hypersensitivity reactions. While no universal antimicrobial desensitization protocols exist, this review critically analyzes previously published desensitization protocols. The purpose of this review is to provide a greater insight for clinicians and institutions to ensure desensitization procedures are efficacious while minimizing potential for patient harm. With an increasing rate of antimicrobial resistance and the critical need to preserve antimicrobial agents, desensitization may represent another option in our antimicrobial stewardship toolkit.
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Affiliation(s)
| | | | - Jay Parekh
- Roosevelt University College of Pharmacy, Schaumburg, IL 60173, USA
| | - Jason Val G Alegro
- Mount Sinai Hospital, Chicago, IL 60608, USA.
- Roosevelt University College of Pharmacy, Schaumburg, IL 60173, USA.
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30
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Verma A, Chen K, Bender C, Gorney N, Leonard W, Barnette P. PEGylated E. coli asparaginase desensitization: an effective and feasible option for pediatric patients with acute lymphoblastic leukemia who have developed hypersensitivity to pegaspargase in the absence of asparaginase Erwinia chrysanthemi availability. Pediatr Hematol Oncol 2019; 36:277-286. [PMID: 31296092 DOI: 10.1080/08880018.2019.1634778] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Asparaginase is an important component of multi-agent chemotherapy for the treatment of pediatric acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LLy). Hypersensitivity to the PEGylated form, pegaspargase, is the most common toxicity observed and is ideally addressed by substituting multiple doses of erwinia asparaginase for each subsequent dose of pegaspargase. An international shortage of erwinia asparaginase has limited the therapeutic options for those experiencing pegaspargase hypersensitivity. Here, we report pegaspargase can be safely administered, while maintaining sustained levels of asparaginase activity, to patients who have had a prior hypersensitivity reaction to pegaspargase by using a standard rapid desensitization protocol. Ten patients with prior hypersensitivity reactions to pegaspargase were treated by using a standardized rapid desensitization protocol. Eight patients had therapeutic asparaginase levels between days 4 and 7 of ≥0.05 IU/mL, and seven patients continued to have sustained levels above ≥0.1 IU/mL between days 10 and 14. Based on chemotherapy regimens, five of these patients successfully received more than one dose of pegaspargase utilizing this protocol.
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Affiliation(s)
- Anupam Verma
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, School of Medicine , Salt Lake City , Utah , USA
| | - Karin Chen
- Department of Pediatrics, Division of Allergy & Immunology, University of Utah, School of Medicine , Salt Lake City , Utah , USA
| | - Cynthia Bender
- Department of Pharmacy, Primary Children's Hospital , Salt Lake City , Utah , USA
| | - Nathan Gorney
- Department of Pharmacy, Primary Children's Hospital , Salt Lake City , Utah , USA
| | - Whitney Leonard
- Department of Pharmacy, Primary Children's Hospital , Salt Lake City , Utah , USA
| | - Phillip Barnette
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, School of Medicine , Salt Lake City , Utah , USA
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Kendirlinan R, Gümüşburun R, Çerçi P, Özbek E, Altıner S, Çelebi Sözener Z, Soyyiğit Ş, Aydın Ö, Bavbek S. Rapid Drug Desensitization with Chemotherapeutics (Platins, Taxanes, and Others): A Single-Center Retrospective Study. Int Arch Allergy Immunol 2019; 179:114-122. [PMID: 30893688 DOI: 10.1159/000496745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rapid drug desensitization (RDD) induces a temporary tolerance to chemotherapeutics that induce hypersensitivity reactions (HSRs). PURPOSE Our objective is to report our experience with RDD to platins, taxanes, etoposide, doxorubicin, and irinotecan. METHODS The study was conducted as a retrospective chart review of patients with symptoms of HSRs to chemotherapeutics. HSRs were classified as grade I, II, or III, based on their severity. Skin prick/intradermal tests were performed with implicated chemotherapeutics. A 12-step RDD protocol was used. RESULTS The study consisted of 38 women and 3 men (mean age 53.3 ± 11.6 years). Patients had ovarian (n = 13, 31.8%), breast (n = 10, 24.4%), colon (n = 7, 17%), lung (n = 4, 9.8%), and other cancers (n = 7; endometrial sarcoma, testicular cancer, uterine cancer, ampulla of Vater tumor, choledochal tumor, peritonitis carcinomatosa, and Merkel cell carcinoma, n = 1, respectively). Twenty-two patients experienced HSRs to platins, 15 to taxanes, and 4 to other chemotherapeutics (doxorubicin, irinotecan, and etoposide). A total of 122 RDDs (47 to platins, 52 to taxanes, 23 to other chemotherapeutics) were performed. In 25 (61%) patients no reactions occurred during RDD, but breakthrough reactions developed in 16 patients (39%) with platins (n = 11), taxanes (n = 3), doxorubicin (n = 1), and irinotecan (n = 1). RDD procedures could not be completed in only 2 patients with grade II breakthrough reactions to carboplatin and oxaliplatin. CONCLUSION In our experience, 98.3% of 122 RDDs were completed. We found that RDD was safe and effective in this the largest series of RDD with chemotherapeutics in our country.
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Affiliation(s)
- Reşat Kendirlinan
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Reyhan Gümüşburun
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Pamir Çerçi
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Emre Özbek
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Seda Altıner
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Çelebi Sözener
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Şadan Soyyiğit
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Ömür Aydın
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Sevim Bavbek
- Department of Chest Disease, Division of Allergy and Clinical Immunology, Ankara University School of Medicine, Ankara, Turkey,
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Foer D, Marquis K, Romero N, Castells MC. Challenges and safety of beta-lactam desensitization during extracorporeal membrane oxygenation. Ann Allergy Asthma Immunol 2019; 122:661-663. [PMID: 30878628 DOI: 10.1016/j.anai.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Dinah Foer
- Brigham and Women's Hospital, Boston, Massachusetts; Drug Hypersensitivity and Desensitization Center at Brigham and Women's Hospital, Boston, Massachusetts.
| | - Kathleen Marquis
- Brigham and Women's Hospital, Boston, Massachusetts; Drug Hypersensitivity and Desensitization Center at Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Mariana C Castells
- Brigham and Women's Hospital, Boston, Massachusetts; Drug Hypersensitivity and Desensitization Center at Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW Pediatric drug hypersensitivity is a rapidly evolving field. The purpose of this paper is to review the current state of pediatric drug hypersensitivity and highlight new developments in diagnosis and management. RECENT FINDINGS This paper will discuss the safety and use of risk stratification to proceed directly to oral challenge without prior skin testing for β-lactam reactions. We review unique aspects of pediatric drug challenges and desensitizations. It is important to accurately diagnose pediatric drug hypersensitivity reactions through a detailed history, physical examination, and available diagnostic testing. Understanding of the underlying mechanism leads to appropriate classification which is necessary to direct management. The decision to perform drug challenge, desensitization, or recommend avoidance of a medication can have a significant impact on a patient's treatment. Utilization of weight-based dose and infusion rate adjustments for current drug challenge and desensitization protocols optimize success.
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Chen XJC, Fong K, Altshuler D, Dubrovskaya Y, Louie E, Amoroso N, Goldenberg R, Papadopoulos J. Evaluation of Pharmacy-Developed Antibiotic Desensitization Protocols. Ann Pharmacother 2018; 53:229-251. [PMID: 30234369 DOI: 10.1177/1060028018801959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Parameters within reconstitution, storage, stability, and administration may be optimized according to the unique pharmacokinetics of each antibiotic to ensure a successful desensitization. OBJECTIVE The study aims to evaluate the successfulness and safety of antibiotic desensitization protocols developed by the pharmacy department at our institution. METHODS A retrospective study was conducted at an 800-bed, urban, tertiary care, academic medical center. A total of 36 patients 18 years of age or older, admitted to our intensive care units between March 2013 and July 2017, who underwent antibiotic desensitization utilizing our pharmacy developed protocols were included. RESULTS In 36 patients, 61 desensitization cases were identified and included; 17 (47%) were male, 27 (75%) were Caucasian, and the median age was 55 years (range 19-94). In all, 15 different antibiotics were administered for desensitization, with meropenem (n = 12, 20%), ampicillin (n = 7, 11%), piperacillin/tazobactam (n = 7, 11%), and penicillin (n = 7, 11%) being the most common; 59 (97%) of 61 desensitizations were completed successfully with or without experiencing reactions, and 53 (89%) of the successful desensitization cases were completed without reactions. Two cases were categorized as anaphylaxis, which was severe enough to terminate the desensitization process. Of the 59 cases successfully completed, the 6 (10%) cases that experienced reactions were managed successfully during desensitization with completion of the process. Conclusion and Relevance: The findings suggest that our pharmacy-developed antibiotic desensitization protocols are successful and safe and may be adapted by other institutions.
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Affiliation(s)
| | | | | | | | - Eddie Louie
- 1 NYU Langone Health, New York, NY, USA.,2 New York University School of Medicine, New York, NY, USA
| | - Nancy Amoroso
- 1 NYU Langone Health, New York, NY, USA.,2 New York University School of Medicine, New York, NY, USA
| | - Ronald Goldenberg
- 1 NYU Langone Health, New York, NY, USA.,2 New York University School of Medicine, New York, NY, USA
| | - John Papadopoulos
- 1 NYU Langone Health, New York, NY, USA.,2 New York University School of Medicine, New York, NY, USA
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Gutiérrez-Fernández D, Saldaña-Valderas M, de la Varga-Martínez R, Foncubierta-Fernández A, Fernández-Anguita MJ, Fernández-Valle MDC, Medina-Varo F. Hypersensitivity to alemtuzumab. A safe and effective desensitization protocol: A case report. J Oncol Pharm Pract 2018; 25:1016-1020. [PMID: 29792124 DOI: 10.1177/1078155218775473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a successful desensitization to alemtuzumab in one patient diagnosed with T-cell prolymphocytic leukaemia. Alemtuzumab treatment was initiated during infusion number 18, the patient showed cutaneous eruption with a miliary pattern, despite premedication with corticosteroids and antihistamines. The eruption returned with successive alemtuzumab infusions (infusions 19, 20 and 21), remained present for longer and was more severe with each infusion. The patient was referred to our Allergy Unit as it was necessary to maintain alemtuzumab treatment. Total immunoglobulin E level was 3 UI/ml and specific immunoglobulin E against more common pneumo-allergens, food, latex and hamster were inferior to 0.35 UI/ml. Prick test using the undiluted drug (30 mg/ml) and intradermal tests using serial dilutions (1/10, 1/100) were performed. The result of alemtuzumab skin prick test was 4 mm. The intradermal skin test result was positive at 1/100 dilution (papule: 8 mm; erythema: 12 mm). The basophil activation test with alemtuzumab was performed concluding that 10% of the basophils were activated by alemtuzumab. The patient underwent alemtuzumab desensitization according to a 12-step protocol that resolved to be safe and efficacious. Our experience may be helpful for similar clinical cases where the therapeutic options are very limited and a life-threatening condition such T-cell prolymphocytic leukaemia is present. In addition, a careful risk/benefit ratio should be considered and accurate informed consent is mandatory.
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Affiliation(s)
- Diego Gutiérrez-Fernández
- 1 Servicio de Alergología. UGC Neumología-Alergia, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | | | - Maria Del C Fernández-Valle
- 6 Servicio de Hematología, UGC Hematología, Inmunología y Genética, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Fermín Medina-Varo
- 7 Unidad de Reumatología. UGC Cirugía Ortopédica, Traumatología y Reumatología, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Norton AE, Konvinse K, Phillips EJ, Broyles AD. Antibiotic Allergy in Pediatrics. Pediatrics 2018; 141:peds.2017-2497. [PMID: 29700201 PMCID: PMC5914499 DOI: 10.1542/peds.2017-2497] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/11/2022] Open
Abstract
The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.
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Affiliation(s)
- Allison Eaddy Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, and
| | - Katherine Konvinse
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J. Phillips
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, and,John A. Oates Institute for Experimental Therapeutics and Department of Pharmacology, School of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee;,Division of Infectious Disease, Departments of Medicine and,Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee;,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia; and
| | - Ana Dioun Broyles
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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How to Manage Antibiotic Allergy in Cystic Fibrosis? Epidemiologic, Diagnostic, and Therapeutic Aspects. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Witcher RH, Ramirez MM. Successful Phenobarbital Desensitization After DRESS Reaction in the Management of Refractory Status Epilepticus. J Pharm Pract 2018; 32:228-230. [PMID: 29390946 DOI: 10.1177/0897190018756237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiepileptic drug use and is a rare but life-threatening side effect. We present a case of phenobarbital-induced DRESS in a patient who subsequently required phenobarbital and was successfully desensitized. SUMMARY A 5-year-old male presented with medically refractory status epilepticus (SE). He had been trialed on several antiepileptic medications without achieving burst suppression. Burst suppression was achieved with a pentobarbital infusion, and thus, phenobarbital was initiated as the pentobarbital was weaned. After five days of phenobarbital, the patient developed signs and symptoms concerning for DRESS; a punch biopsy confirmed the drug reaction. Two months later, he again developed SE unresponsive to antiepileptic infusions. Burst suppression was achieved with pentobarbital, and it was decided to transition the patient to phenobarbital. Due to concerns of phenobarbital-induced DRESS, the patient underwent a phenobarbital desensitization consisting of 6 doses sequentially administered in 10-fold increasing concentrations before achieving therapeutic dosing. Three days later, the patient achieved therapeutic phenobarbital levels, was weaned off of pentobarbital, and remained seizure-free without recurrence of DRESS. CONCLUSIONS Graded desensitization may be an option to minimize recurrence of DRESS in patients where avoidance of the offending agent is not possible.
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Affiliation(s)
| | - Michelle M Ramirez
- 2 Department of Pediatrics, Division of Critical Care Medicine, NYU School of Medicine, New York, NY, USA
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Pham MN, Ho HE, Desai M. Penicillin desensitization: Treatment of syphilis in pregnancy in penicillin-allergic patients. Ann Allergy Asthma Immunol 2017; 118:537-541. [PMID: 28477786 DOI: 10.1016/j.anai.2017.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Michele N Pham
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hsi-En Ho
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mauli Desai
- Icahn School of Medicine at Mount Sinai, New York, New York.
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41
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McNulty CMG, Park MA. Delayed Cutaneous Hypersensitivity Reactions to Antibiotics: Management with Desensitization. Immunol Allergy Clin North Am 2017; 37:751-760. [PMID: 28965638 DOI: 10.1016/j.iac.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Successful desensitization to mild to moderate delayed cutaneous adverse reaction to antibiotics has been described in a limited number of antibiotics and found to be safe. However, there are ample opportunities to standardize protocols for delayed cutaneous adverse reactions to antibiotics.
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Affiliation(s)
- Caitlin M G McNulty
- Division of Allergic Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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42
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Seki JT, Sakurai N, Lam W, Reece DE. Pomalidomide desensitization in a patient hypersensitive to immunomodulating agents. ACTA ACUST UNITED AC 2017; 24:e328-e332. [PMID: 28874903 DOI: 10.3747/co.24.3572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite progressive treatments with tandem stem-cell transplantation, patients with incurable myeloma eventually succumb to relapsed or refractory disease if left untreated. Promising agents such as proteasome inhibitors and immunomodulating imide drugs (imids), including the newer-generation agent pomalidomide, in combination with lower-dose dexamethasone, have been shown to be effective and to significantly improve and prolong survival in pretreated patients. Although the incidence of pomalidomide hypersensitivity reaction (hsr) in this class of drugs is not as well known, we have documented cutaneous toxicity (grade 3 by the Common Terminology Criteria for Adverse Events, version 4) in 2 separate cases (not yet published). Because the imids are chemically, structurally, and pharmacologically similar, it is not unreasonable to consider possible cross-reactivity in pomalidomide recipients who developed hsr when receiving previous lines of imids. As a patient's advocate, it is only prudent to provide a responsible, and yet practical, means to better address cross-sensitivity for patients. Intervention with the use of a rapid desensitization program (rdp) as a preventive measure should be introduced before initiating pomalidomide. Such a proactive measure for the patient's safety will ensure a smooth transition into pomalidomide treatment. A hsr can be either related or non-related to immunoglobulin E. As imids become an essential treatment backbone for myeloma and other plasma-cell diseases, an increasing number of patients could experience skin and other life-threatening toxicities, resulting in unnecessary discontinuation of these life-prolonging agents. An extemporaneously prepared pomalidomide suspension developed at our centre enables patients to undergo rdp safely. Patients enjoy a good quality of life and clinical response after the rdp procedure.
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Affiliation(s)
- J T Seki
- Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network.,Leslie Dan Faculty of Pharmacy, University of Toronto; and
| | - N Sakurai
- Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network
| | - W Lam
- Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network
| | - D E Reece
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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Macy E, Romano A, Khan D. Practical Management of Antibiotic Hypersensitivity in 2017. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:577-586. [DOI: 10.1016/j.jaip.2017.02.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 12/19/2022]
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Davies GI, Davies D, Charles S, Barnes SL, Bowden D. Successful desensitization to deferasirox in a paediatric patient with β-Thalassaemia major. Pediatr Allergy Immunol 2017; 28:199-201. [PMID: 27797415 DOI: 10.1111/pai.12677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Domenica Davies
- Department of Pharmacy, Monash Health, Clayton, Vic., Australia
| | - Sarah Charles
- Department of Pharmacy, Monash Health, Clayton, Vic., Australia
| | - Sara Laura Barnes
- Departments of Allergy and General Medicine, Monash Health, Clayton, Vic., Australia.,Monash University, Clayton, Vic., Australia
| | - Donald Bowden
- Monash University, Clayton, Vic., Australia.,Thalassaemia Services, Monash Health, Clayton, Vic., Australia
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Mühlmeier G, Hausch R, Maier H. [Adaptive desensitization for acetylsalicylic acid hypersensitivity: A success story?]. HNO 2016; 63:707-14. [PMID: 26395185 DOI: 10.1007/s00106-015-0065-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adaptive desensitization still remains the only causative therapy for acetylsalicylic acid (ASA) hypersensitivity and is carried out nearly worldwide. To date there are hardly any data available on disease development under current desensitization therapy and longitudinal data in particular are missing. STUDY DESIGN Out of a large collective of patients with proven hypersensitivity to ASA, 194 patients with initiated desensitization treatment were observed for periods up to 5 years (average 32 months). RESULTS Patients with immediate reactions to systemic challenge tests revealed a response rate of 77% after 12 months of therapy. In this period 12% reached complete remission, 38% showed a clear reduction in symptoms, 32% reached partial remission, 13% remained unchanged and 5% suffered from disease progression. CONCLUSION Adaptive desensitization therapy for hypersensitivity to ASA has been shown to be an effective causative therapy and chronic hyperplastic sinusitis as well as bronchial asthma could be improved. For the determination of maintenance dosages and required time periods more data are needed.
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Affiliation(s)
- G Mühlmeier
- Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - R Hausch
- Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - H Maier
- Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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Gómez-Duque M, Sala-Cunill A, Farriols A, Cardona V, Luengo O. Safe and Time-Saving Desensitization Protocol to Intravenous Etoposide. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:793-4. [DOI: 10.1016/j.jaip.2016.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/03/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
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Ozcan J, Nicholls K, Jones K. Immunoglobulin E-Mediated Hypersensitivity Reaction to Ketamine. Pain Pract 2016; 16:E94-8. [DOI: 10.1111/papr.12466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/10/2016] [Accepted: 03/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- John Ozcan
- Department of Anaesthesia; The Royal Women's Hospital; Parkville Victoria Australia
| | - Katherine Nicholls
- Department of Immunology and Allergy; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Karin Jones
- Department of Anaesthesia; The Royal Women's Hospital; Parkville Victoria Australia
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Ercan N, Bostanci IB, Ozmen S, Ertugrul A. Is premedication a necessity before galsulfase replacement therapy? Ann Allergy Asthma Immunol 2016; 117:200-2. [PMID: 27346567 DOI: 10.1016/j.anai.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Nazli Ercan
- Department of Pediatric Immunology and Allergy, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Ilknur Birol Bostanci
- Department of Pediatric Immunology and Allergy, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Serap Ozmen
- Department of Pediatric Immunology and Allergy, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aysegul Ertugrul
- Department of Pediatric Immunology and Allergy, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Capanoglu M, Dibek Misirlioglu E, Azkur D, Vezir E, Guvenir H, Gunduz M, Toyran M, Civelek E, Kocabas CN. IgE-Mediated Hypersensitivity and Desensitisation with Recombinant Enzymes in Pompe Disease and Type I and Type VI Mucopolysaccharidosis. Int Arch Allergy Immunol 2016; 169:198-202. [DOI: 10.1159/000446154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 04/11/2016] [Indexed: 11/19/2022] Open
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50
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Adelman J, McLean C, Shaigany K, Krouse JH. The Role of Surgery in Management of Samter's Triad: A Systematic Review. Otolaryngol Head Neck Surg 2016; 155:220-37. [PMID: 27071444 DOI: 10.1177/0194599816640723] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/03/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Aspirin-exacerbated respiratory disease (AERD) represents a severe form of chronic rhinosinusitis (CRS) characterized by nasal polyposis, bronchial asthma, and aspirin intolerance. This syndrome, known as Samter's triad, is more difficult to manage than routine CRS and poses a challenge to the treating clinician. We performed a systematic review of the literature to determine the role of endoscopic sinus surgery in patients with AERD who are on adjuvant medical therapies. DATA SOURCES PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Cochrane Technology Assessments, Cochrane Economic Evaluations, Cochrane Groups, and Clinicaltrials.gov. REVIEW METHODS A systematic review of the literature was performed using the 2009 PRISMA guidelines. Studies with both preoperative and postoperative data for patients with AERD who underwent sinus surgery were considered appropriate for inclusion. Publications were written in English, included patients aged 18 years or older, and had a minimum follow-up of 3 months. RESULTS Eighteen studies met criteria for inclusion in our review. The primary outcome was change in symptom profile as measured by sinonasal and asthma symptom scores. Most studies demonstrated improvement in sinus- and asthma-related symptoms and quality-of-life measures after endoscopic sinus surgery. CONCLUSION This review, which did not exclude the use of concomitant medical therapy, suggests that surgery is beneficial in AERD management. Evidence demonstrates improvement in sinonasal and asthma symptom severity and frequency, radiographic and endoscopy scores, and quality of life after surgery.
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Affiliation(s)
- Julie Adelman
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Caitlin McLean
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Kevin Shaigany
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - John H Krouse
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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