Drug desensitization in 17-year-old male with Mast Cell Activation Syndrome, pneumonia, and antibiotic hypersensitivities

Abstract

Rapid desensitization (RD) is utilized in order to provide necessary medications to patients with drug hypersensitivity. RD is performed in a closely monitored setting to protect patients from severe anaphylactic or anaphylactoid reactions. A recently classified syndrome, mast cell activation syndrome (MCAS), has been defined by episodic symptoms caused by mast cell mediators and is associated with specific laboratory markers. Patient with MCAS and history of systemic reactions to ceftriaxone and azithromycin presented with pneumonia requiring treatment with ceftriaxone and azithromycin, both provided via desensitization protocols. Desensitization for drug hypersensitivities in the setting of MCAS presents several controversial issues as mechanism of hypersensitivity may not be related to IgE-mediated but rather non-specific mast-cell degranulation. The controversies of diagnosis and management of antibiotic hypersensitivity in patients with MCAS discussed. Our case demonstrates that desensitization protocols can be used in MCAS patients with noted hypersensitivities. The intricacies of desensitization in the setting of MCAS are not fully understood and will require further research and characterization.

Novel approach to idursulfase and laronidase desensitization in type 2 and type 1 S mucopolysaccharidosis (MPS)

“…Rapid desensitization procedures by intravenous infusion have proved effective and safe and have been employed in the management of allergy to a variety of drugs, such as chemotherapeutic drugs, antibiotics, monoclonal antibodies, iron therapy, etc. [33][34][35][36][37][38][39][40][41][42][43][44][45].…”

“…Different antibiotics were administered successfully by rapid desensitization schedules, such as penicillin G, in patients with syphilis [33,34], and ceftazidime/avibactam in klebsiella pneumoniae severe respiratory infection Spataro et al Orphanet Journal of Rare Diseases (2022) 17:402 [35]. Moreover, the literature abounds of case reports, such as the successful 4-bag/16-step rapid desensitization for ceftriaxone performed in 17-year-old patients, also affected by mast cell activation syndrome [36].…”

The Role of Mast Cells in the Induction and Maintenance of Inflammation in Selected Skin Diseases

“…Desensitization consists in administering successively increasing doses every 15 to 30 min, until the achievement of clinical tolerance to the full therapeutic dose which causes the stabilization of basophiles and MCs. The mechanism has not been fully understood, but it is believed to be the result of the subthreshold stimulation of the antigen by the hapten–carrier conjugate [ 100 ]. Staso et al described the case of a patient with MCAS and a history of general systemic reactions to ceftriaxone and azithromycin who required the administration of these drugs to treat pneumonia [ 100 ].…”

Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

“…Oral DPT remains as the gold standard for diagnosis 87 . A successful desensitization protocol was reported in a case of mast cell activation syndrome 88 (Table 2).…”