A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature

Abstract

Gonadotropin-releasing hormone analogues are used in the treatment of prostate cancer, breast cancer, endometriosis, and uterine leiomyomas in adults and often in the treatment of precocious puberty in children. Many adverse effects have been reported for gonadotropin-releasing hormone analogues, but anaphylaxis is rarely reported as an adverse effect. Frequent cross-reactions, particularly during childhood, and diversity of the time of onset of anaphylactic manifestations complicate the diagnosis. A patient who exhibited anaphylactic allergic reactions to two different agents used in the treatment of central precocious puberty presented here because the case has an atypical course and is the first in the literature.

Transient Arterial Hypertension Induced by Gonadotropin-Releasing Hormone Agonist Treatment for Central Precocious Puberty

“…Triptorelin, a long-lasting GnRHa, decreases testosterone levels in boys and estrogen levels in girls. Triptorelin is a widely used drug with few reported adverse effects, such as erythema, bruising, pain, sterile abscesses, menopausal-like symptoms, and anaphylaxis (2, 3). So far secondary arterial hypertension (HTN) has been reported in only 3 patients with CPP (4–6).…”

Management of Systemic Hypersensitivity Reactions to Gonadotropin-Releasing Hormone Analogues during Treatment of Central Precocious Puberty

“…Because of the structural homology of GnRH analogues and potential cross-reactivity, patients may rarely encounter allergic reactions to more than one GnRH analogue. Ökdemir et al [5] reported a CPP case with proven allergy to both LA and TA depot preparations. Similarly, 1 patient (case 1) in our cohort was reactive to both LA and TA and preferred to cease the treatment.…”

“…In the literature, several types of allergic reactions to GnRH analogue treatment have been reported ranging from cutaneous adverse reactions such as urticaria, acne, alopecia, pruritus, purpuric rash, photosensitivity, injection site reactions (flare or subcutaneous nodule formation), mycosis-fungoides-like eruption to serum sickness and anaphylaxis [3,4]. However, only case reports have been presented until now and no systematic review or guideline for the management of allergic reactions to GnRH analogues is available [1,[5][6][7][8][9][10][11][12]. On the other hand, the frequency of CPP and the use of GnRH analogues has been increasing in the recent years, which warrants a proper surveillance and management of potential side effects of the treatment.…”

Anaphylactic reaction to gonadotropin‐releasing hormone analogues: a pediatric case report

“…Anaphylactic reactions in patients receiving this treatment are very rare. In the current literature, only few cases have been reported . We describe a girl with idiopathic central precocious puberty who showed an anaphylactic reaction after administration of GnRH analogues.…”