Desensitization of epoetin‐α in a confirmed case of acute exanthematic pustulosis

Pérez, Francisco Javier Ruano; Garcimartin, Maria Isabel; Torre, Maria Vazquez de La; Blanca, M.; Cantó, Gutiérrez

doi:10.1111/j.1398-9995.2009.02140.x

Cited by 8 publications

(11 citation statements)

References 3 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our opinion, desensitization with the culprit drug is absolutely contraindicated (Table ) in severe or life‐threatening delayed drug hypersensitivity reactions, such as Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug hypersensitivity syndrome (DHS), also called drug reaction/rash with eosinophilia and systemic symptoms (DRESS), or drug‐induced hypersensitivity syndrome (DiHS) . In acute generalized exanthematous pustulosis (AGEP), careful consideration is needed, even though there is a report of a successful desensitization with epoetin‐α in a patient with severe renal insufficiency . Patients with extensive mucosal ulcerations, cutaneous or systemic vasculitis, drug‐induced autoimmune disorders, and severe general symptoms, for example drug fever, arthritis, or generalized lymphadenopathy, should not be desensitized.…”

Section: Contraindicationsmentioning

confidence: 99%

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

Scherer

Brockow

Aberer

et al. 2013

Allergy

190

173

View full text Add to dashboard Cite

Drug hypersensitivity may deprive patients of drug therapy, and occasionally no effective alternative treatment is available. Successful desensitization has been well documented in delayed drug hypersensitivity reactions. In certain situations, such as sulfonamide hypersensitivity in HIV-positive patients or hypersensitivity to antibiotics in patients with cystic fibrosis, published success rates reach 80%, and this procedure appears helpful for the patient management. A state of clinical tolerance may be achieved by the administration of increasing doses of the previously offending drug. However, in most cases, a pre-existent sensitization has not been proven by positive skin tests. Successful re-administration may have occurred in nonsensitized patients. A better understanding of the underlying mechanisms of desensitization is needed. Currently, desensitization in delayed hypersensitivity reactions is restricted to mild, uncomplicated exanthems and fixed drug eruptions. The published success rates vary depending on clinical manifestations, drugs, and applied protocols. Slower protocols tend to be more effective than rush protocols; however, underreporting of unsuccessful procedures is very probable. The decision to desensitize a patient must always be made on an individual basis, balancing risks and benefits. This paper reviews the literature and presents the expert experience of the Drug Hypersensitivity Interest Group of the European Academy of Allergy and Clinical Immunology.Drug hypersensitivity reactions account for more than 15% of all adverse drug reactions and are an important problem in clinical medicine. Drug hypersensitivity reactions may be allergic or nonallergic. Allergic reactions are IgE-or non-IgE-mediated (1). They have also been classified into immediate and nonimmediate (2). Immediate drug hypersensitivity reactions occur within 1 h after drug exposure and can be IgE-mediated or linked to a nonspecific histamine release. Nonimmediate or delayed reactions manifest after more than 1 h. In some of these reactions, a T-cell-mediated Allergy 68 (2013) 844-852

show abstract

Section: Contraindicationsmentioning

confidence: 99%

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

Scherer

Brockow

Aberer

et al. 2013

Allergy

190

173

View full text Add to dashboard Cite

show abstract

“…Although the family declined a skin biopsy for confirmation due to the invasive nature of this procedure, the clinical presentation was consistent with DTH. Therefore, we followed a previously published desensitization protocol [ 6 ], which failed to induce tolerance to the medication for our patient, whose rash recurred. Because of the relatively benign nature of her allergic response, we opted to try a novel desensitization protocol, with longer intervals between dose escalations, which can increase the likelihood for successful desensitization [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since the patient required recombinant human erythropoietin to avoid the need for recurrent blood transfusions, we followed a previously published two-day epoetin alfa desensitization protocol reported in an adult who had experienced maculopapular eruptions after receiving epoetin alfa [ 6 ]. Our protocol was adjusted for the pediatric patient’s weight to achieve a target dose of 700 IU (Table 1 ).…”

Section: Case Presentationmentioning

confidence: 99%

“…Reports of hives or anaphylaxis immediately following administration of epoetin alfa have suggested IgE-mediated hypersensitivity [ 1 – 5 ]. Some of these patients were able to tolerate epoetin alfa after 3-h or 2-day desensitization [ 3 , 4 , 6 ]. Other reports describe delayed-type hypersensitivity (DTH) rashes [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Other reports describe delayed-type hypersensitivity (DTH) rashes [ 7 ]. Rarely, acute generalized exanthematous pustulosis can occur weeks after starting epoetin alfa [ 6 ]. Slow outpatient desensitization to epoetin alfa has not been described.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A novel outpatient desensitization protocol for recombinant human erythropoietin allergy in a pediatric patient

Rosa

Vuong

Haskin

et al. 2018

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

BackgroundRecombinant human erythropoietin, such as epoetin alfa and darbepoetin alfa, is an important therapy for anemia due to chronic renal failure. Allergy to recombinant human erythropoietin and the need for desensitization are rare.Case presentationWe report here a novel epoetin alfa outpatient desensitization protocol in a girl who developed delayed cutaneous hypersensitivity to subcutaneous epoetin alfa and intravenous darbepoetin alfa. An initial attempt at traditional epoetin alfa desensitization failed, so we created a slower 17-day outpatient desensitization that succeeded and allowed treatment continuation.ConclusionsThis case highlights the notion that delayed-type hypersensitivity to recombinant human erythropoietin can occur as evident by reproducible reactions after repeated exposures and slow outpatient desensitization can be considered when a trial of more rapid induction of tolerance is unsuccessful.

show abstract

Pustulose exanthématique aiguë généralisée à l’époétine alpha et désensibilisation

Schmutz

Barbaud

Tréchot³

2010

Annales de Dermatologie et de Vénéréologie

View full text Add to dashboard Cite

Desensitization of epoetin‐α in a confirmed case of acute exanthematic pustulosis

Cited by 8 publications

References 3 publications

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

A novel outpatient desensitization protocol for recombinant human erythropoietin allergy in a pediatric patient

Pustulose exanthématique aiguë généralisée à l’époétine alpha et désensibilisation

Contact Info

Product

Resources

About