An Aphylactic Reaction to Cyclosporin in a Bone Marrow Transplant Recipient

Habboush, H.W.; Hann, Ian

doi:10.1111/j.1365-2141.1986.tb02916.x

Cited by 8 publications

(3 citation statements)

References 2 publications

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“…Although anaphylaxis to parenteral cyclosporine has been reported since 1984, 9 the first case of such reaction in HSCT patients was described in 1986 in a five-yearold girl with Acute Lymphoblastic Leukemia. 10 However, the number of case reports regarding hypersensitivity reaction to IV cyclosporine in patients undergoing HSCT remained very low. 11 This article reports a patient with major thalassemia and a previous history of hypersensitivity reaction to vitamin K who experienced anaphylaxis to the first dose of both IV cyclosporine and tacrolimus before allogeneic HSCT.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that there are some reports regarding a successful switch to oral cyclosporine in patients who were allergic to IV formulation. [10][11][12]15,16 To the best of our knowledge, there is only one case report regarding a successful switch to oral formulation of tacrolimus in an HSCT patient experiencing anaphylactic reaction to IV forms of CNIs. 14 Although the exact mechanism of cremophor-containing drugs-induced hypersensitivity is unclear, some different hypotheses have been proposed which include IgE-mediated activation of a complement pathway and release of histamine.…”

Section: Discussionmentioning

confidence: 99%

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Successful switch to oral tacrolimus in a patient with hypersensitivity reaction to parenteral vitamin K, cyclosporine, and tacrolimus: A case report

Taghvaye‐Masoumi

Sadeghi

Hadjibabaie

2019

J Oncol Pharm Pract

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Introduction Calcineurin inhibitors are widely used for the prevention and treatment of graft versus host disease in patients undergoing allogeneic hematopoietic stem cell transplantation, and successful treatment with calcineurin inhibitors is very important for the management of these cases. Case report A 19-year-old man with thalassemia major experienced hypersensitivity reaction to parenteral vitamin K, cyclosporine, and tacrolimus before hematopoietic stem cell transplantation. All three episodes of reaction appeared a few minutes after administration of offended drugs and cause systemic signs and symptoms of anaphylaxis, i.e. itching, flushing, difficulty in breathing, and hypotension. Management and outcome Hypersensitivity reaction was fully controlled by immediately discontinuing the drug and administering hydrocortisone, chlorpheniramine, epinephrine, and intravenous fluids. During hospitalization, the patient tolerated oral tacrolimus without any complication. Discussion It appears that Cremophor EL (polyoxyethylated castor oil) which acts as a carrier, solubilizer, and emulsifier in intravenous calcineurin inhibitors is responsible for the occurrence of anaphylactic reaction (anaphylaxis); therefore, it is suggested that the administration of cremophor-containing drug should be avoided in patients with a previous history of hypersensitivity reaction to one of these drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful switch to oral tacrolimus in a patient with hypersensitivity reaction to parenteral vitamin K, cyclosporine, and tacrolimus: A case report

Taghvaye‐Masoumi

Sadeghi

Hadjibabaie

2019

J Oncol Pharm Pract

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“…13 Five of six healthy males who received 190 mg of cyclosporine intravenously experienced anaphylactic reactions. However, anaphylactic reactions to intravenous cyclosporine have been described in only four cases after BMT 10,11,14,15 and in eight cases of organ transplantation, 2,3,9,[16][17][18] suggesting that the incidence of anaphylactic reactions to cyclosporine is very low in BMT and organ transplant recipients. Prophylactic anti-allergic premedication is known to decrease the incidence of anaphylactic reactions to paclitaxel in which polyoxyethylated castor oil is used.…”

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confidence: 99%

Intravenous cyclosporine and tacrolimus caused anaphylaxis but oral cyclosporine capsules were tolerated in an allogeneic bone marrow transplant recipient

Takamatsu

Ishizu

Ichinose

et al. 2001

Bone Marrow Transplant

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Summary:A Japanese female patient with angioimmunoblastic T cell lymphoma underwent allogeneic bone marrow transplantation (BMT) from her brother. Cyclosporine at a dose of 3 mg/kg was started by continuous infusion over 24 h on day −1 of BMT. Within a couple of minutes after the infusion was begun, she developed diffuse pruritic erythema on her whole body and tachycardia. The infusion was immediately stopped and corticosteroid was given, resulting in disappearance of the erythema gradually. She was then switched to intravenous tacrolimus. However, she suffered urticalial erythema again. Since polyoxyethylated castor oil, a solubilizer used in the injective formulation of both cyclosporine and tacrolimus, is considered to be responsible for the reaction, she was given oral capsules of cyclosporine (Sandimmun) in which polyoxyethylated castor oil was not contained. No further anaphylactic reaction was observed. The BM cells were successfully engrafted without causing severe GVHD. She was discharged on cyclosporine capsules without any further adverse effects. Anaphylaxis to intravenous cyclosporine and tacrolimus is a very rare but a serious complication. Our present case indicates that oral capsule of Sandimmun is a safe alternative to prevent GVHD in such a case of anaphylactic reaction against intravenous formulation. Bone Marrow Transplantation (2001) 28, 421-423. Keywords: anaphylaxis; cyclosporine; tacrolimus Cyclosporine has been widely used to prevent graft-versushost disease (GVHD) in allogeneic bone marrow transplantation (BMT) as well as to allow engraftment of transplanted organs including kidney, liver and heart allografts. ever, once anaphylaxis has occurred in a BMT recipient, another immunosuppressive agent is needed since high-dose chemotherapy with or without total body irradiation has been already given prior to the start of cyclosporine, for GVHD prophylaxis. Tacrolimus is an alternative agent often used for the treatment of GVHD when cyclosporine is not effective. Here, we report a patient who developed anaphylaxis to both intravenous cyclosporine and tacrolimus but who tolerated oral cyclosporine in capsule form.A 45-year-old Japanese woman with angioimmunoblastic T cell lymphoma was admitted for allogeneic BMT from her HLA-identical brother. She had had no history of drug allergy while she received anti-neoplastic chemotherapy for 8 months. Following 2 Gy of total body irradiation once daily for 3 consecutive days (total 6 Gy) and the intravenous administration of cytarabine 1 g/m 2 twice daily for 2 days and cyclophosphamide 50 mg/kg once daily for 2 days, she started cyclosporine 1 day prior to BMT. Cyclosporine at a dose of 3 mg/kg was mixed in 500 ml of 5% glucose solution for continuous 24 h infusion. A couple of minutes after the start of the infusion, she developed diffuse pruritic erythema with wheals on her extremities, trunk and face. Her pulse rate increased to 110/min but the blood pressure and respiratory rate did not alter. The infusion was immediately stopped and corticostero...

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Cyclosporin A and bone marrow transplantation

Atkinson¹

1989

Cyclosporin

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An Aphylactic Reaction to Cyclosporin in a Bone Marrow Transplant Recipient

Cited by 8 publications

References 2 publications

Successful switch to oral tacrolimus in a patient with hypersensitivity reaction to parenteral vitamin K, cyclosporine, and tacrolimus: A case report

Successful switch to oral tacrolimus in a patient with hypersensitivity reaction to parenteral vitamin K, cyclosporine, and tacrolimus: A case report

Intravenous cyclosporine and tacrolimus caused anaphylaxis but oral cyclosporine capsules were tolerated in an allogeneic bone marrow transplant recipient

Cyclosporin A and bone marrow transplantation

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