Desensitization for immediate hypersensitivity to oral dimethyl fumarate (Tecfidera)

Delayed Hypersensitivity Reaction to Oral Dimethyl Fumarate

“…The mechanism of action of DMF comprises suppression of allergen-induced T-cell proliferation and modulation of the cytokine balance by suppressing only IFN- and not IL-5 [1-2], thus restoring the T H 1/T H 2 balance. It is also involved in interference with the intracellular redox balance and activation of nuclear (erythroidderived 2)-like 2 related factor-mediated antioxidative response pathways leading to additional cytoprotective effects, and it seems to exert a marked effect on mitochondria [1][2][3].We present the case of a 46-year-old woman with relapsing-remitting MS who had received several treatment options. However, given that she was a frequent traveller, she switched to DMF, which is a convenient, practical, efficacious first-line treatment for MS. Several hours after intake of the first dose of 240 mg, she developed generalized confluent and intensely pruritic wheals without angioedema or other systemic symptoms.…”

“…The mechanism of action of DMF comprises suppression of allergen-induced T-cell proliferation and modulation of the cytokine balance by suppressing only IFN- and not IL-5 [1][2], thus restoring the T H 1/T H 2 balance. It is also involved in interference with the intracellular redox balance and activation of nuclear (erythroidderived 2)-like 2 related factor-mediated antioxidative response pathways leading to additional cytoprotective effects, and it seems to exert a marked effect on mitochondria [1][2][3].…”

“…She denied having taken NSAIDs, infection, or other possible causes of urticaria and had never experienced urticaria during her lifetime. Following recently published indications [1], we performed a skin prick test (SPT) with DMF at 7 µg/mL and intradermal tests with DMF at 0.7 µg/mL and 0.07 µg/mL. The results were negative.…”

“…Phytohemagglutinin A (PHA) as a control mitogen LTT is considered weakly positive or doubtful if the stimulation index (SI) is between 2 and 3 and definitely positive if the SI is >3 proliferation and proinflammatory transcription factors, as well as secretion of asthma-relevant cytokines in primary human lung cells. In nickel-allergic patients, DMF has been shown to have a down regulatory effect on T H 1 T cells, whereas T H 2 cells were unaffected [1]. Moreover, sensitization DMF has been reported to lead to delayed-type contact dermatitis and contact urticaria to footwear, clothing, and furniture, where it is used as a mold growth inhibitor [9].…”

“…DMF was approved as an oral drug in 2013, and, since then, only 1 case of immediate hypersensitivity has been reported [1]. The patient was a 57-year-old woman with MS treated with oral DMF who reported immediate (within minutes) hypersensitivity symptoms, namely, rapid onset of urticaria with confluent wheals and itching 2 days after reaching the twice-daily dose of 240 mg.…”