Successful rapid rituximab desensitization in an adolescent patient with nephrotic syndrome: Increase in number of Treg cells after desensitization

Aydoğan, Metin; Yologlu, Nail; Gacar, Gülçin; Uyan, Zeynep Seda; Eser, Isil; Karaöz, Erdal

doi:10.1016/j.jaci.2013.02.004

Cited by 23 publications

(20 citation statements)

References 6 publications

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“…RDD protocols to mAbs have been well defined in adults but there is limited experience in the pediatric population. Successful desensitization protocols in children has been reported for rituximab [125,134,135], infliximab [103,136] and tocilizumab [135]. Desensitization to infliximab had already successfully performed in 2001 for a 10-year-old boy with severe ulcerative colitis who had experienced an immediate severe anaphylactic/anaphylactoid reaction after repeated infusions of this drug.…”

Section: Desensitizationmentioning

confidence: 99%

“…Two hundred and eight milligrams of drug (5 mg/kg) was administered, in 11 escalating increments every 15 min, ranging from 2 micrograms to 80 mg [136]. Aydogan et al [135] reported a case of a 16-year-old boy with a steroid-resistant nephrotic syndrome who reacted to rituximab. Rituximab was administered using a 12-step RDD [123] with minor modifications.…”

Section: Desensitizationmentioning

confidence: 99%

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Hypersensitivity Reactions to Monoclonal Antibodies in Children

et al. 2020

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Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available.

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Section: Desensitizationmentioning

confidence: 99%

Section: Desensitizationmentioning

confidence: 99%

Hypersensitivity Reactions to Monoclonal Antibodies in Children

et al. 2020

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“…Rituximab may have further use in the transplant population, as it has shown efficacy in both prophylaxis against acute GVHD and treatment of steroid-refractory chronic GVHD in allogenic stem cell transplant patients, which is believed to be a B cell-dependent process 171-173 . More studies within the transplant population are needed to better understand the effects of B cell depletion on Treg 167,174-176 .…”

Section: Impact Of Alternative Immunosuppressive Agents On Tregmentioning

confidence: 99%

Impact of Immune-Modulatory Drugs on Regulatory T Cell

2016

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Immunosuppression strategies that selectively inhibit effector T cells while preserving and even enhancing CD4+FOXP3+ regulatory T cells (Treg) permit immune self-regulation and may allow minimization of immunosuppression and associated toxicities. Many immunosuppressive drugs were developed before the identity and function of Treg were appreciated. A good understanding of the interactions between Treg and immunosuppressive agents will be valuable to the effective design of more tolerable immunosuppression regimens. This review will discuss preclinical and clinical evidence regarding the influence of current and emerging immunosuppressive drugs on Treg homeostasis, stability, and function as a guideline for the selection and development of Treg-friendly immunosuppressive regimens.

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“…1,6 The other case report described desensitization to infliximab in a 14-year-old patient using a 13-step protocol. This protocol started at a lower dose than the protocol we described for rituximab (1/1,000,000 compared with our 1/100,000) and tripled the dose in each step instead of doubling the dose.…”

Section: Discussionmentioning

confidence: 99%

“…While HSRs and desensitization to mAbs have been well described in adults, [1][2][3] to our knowledge, the experience in children is limited to only two case reports, including only one to rituximab. 5,6 We discuss HSRs and rapid desensitization to rituximab in a tertiary care pediatric center, including reaction evaluation, pretreatment regimens, a successful desensitization protocol, and outcomes. To our knowledge, this is the first report of a series of mAb desensitizations in a pediatric population.…”

mentioning

confidence: 99%

Rituximab Desensitization in Pediatric Patients: Results of a Case Series

Dilley

Lee

Platt

et al. 2016

Pediatric Allergy, Immunology, and Pulmonology

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Rituximab is a monoclonal antibody (mAb) primarily used to treat oncologic and autoinflammatory conditions. Although hypersensitivity reactions (HSRs) and desensitization protocols to mAbs have been well described in adults, the experience in the pediatric population is very limited. We sought to determine the safety and efficacy of desensitization to rituximab in the pediatric population at our institution. We retrospectively reviewed the experience with HSRs and desensitization to rituximab during a 5-year period in our tertiary care pediatric center, including reaction evaluation, premedication regimens, and desensitization procedures and protocols. A total of 17 desensitizations to rituximab were performed in three patients. A 14-year-old patient underwent successful desensitization to rituximab using a published adult protocol without incident. Two younger patients (ages 7 years and 23 months) experienced significant reactions during initial desensitization attempts. Therefore, we designed a modified desensitization protocol to rituximab, with particular attention to the rate of infusion as mg/kg/h. This new patient weight-based protocol was successfully used in a total of 13 desensitizations in these two patients. Desensitization to rituximab was a safe and effective procedure in our pediatric population. We present a new patient weight-based desensitization protocol for pediatric patients who develop HSRs to rituximab, with particular usefulness for younger pediatric patients and potential utility in pediatric patients with HSRs to other mAbs.

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Successful rapid rituximab desensitization in an adolescent patient with nephrotic syndrome: Increase in number of Treg cells after desensitization

Cited by 23 publications

References 6 publications

Hypersensitivity Reactions to Monoclonal Antibodies in Children

Hypersensitivity Reactions to Monoclonal Antibodies in Children

Impact of Immune-Modulatory Drugs on Regulatory T Cell

Rituximab Desensitization in Pediatric Patients: Results of a Case Series

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