Drug Desensitization in Immediate-Type Hypersensitivity

Castells, Mariana; Hamadi, Sahar; Sanchez, Maria Sanchez

doi:10.1007/978-3-030-82743-4_12

Cited by 2 publications

(4 citation statements)

References 88 publications

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“…Patients with a history of atopy are at risk of developing severe and prolonged contact dermatitis [14]. Constant allergen stimulation, age, and atopy may predispose to long-lasting patch test reactions.…”

Section: Bag# Step Concentrationmentioning

confidence: 99%

Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge

Mann¹,

Caruana²,

Luo³

et al. 2022

Cureus

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Adult growth hormone (GH) deficiency is rare and requires replacement with extrinsic/synthetic injection. GH hypersensitivity has been reported; specifically, atopic patients may develop rashes from somatotropin therapy. Allergic and non-allergic skin reactions to recombinant human GH are uncommon and infrequently reported. We describe a graded-dose challenge with intravenous Norditropin® in a 65-year-old atopic adult woman who developed a severe whole-body rash with Norditropin FlexPro® administration on several occasions but was negative on skin-prick testing to Norditropin® percutaneously and intradermally, but the patch testing was positive for gold and nickel.The patient was registered as a direct admission to the emergency room at a university hospital for a rapid antigen coronavirus disease 2019 (COVID-19) testing after having received two COVID-19 vaccinations and re-testing four months after vaccination. She was then directly admitted to a non-COVID-19 intensive care unit with direct bedside supervision by a registered nurse and a physician board certified in internal medicine, allergy/immunology, and pulmonary diseases. The patient brought a Norditropin® pen which our pharmacy team attached to a compatible syringe for dilutions. A graded dose challenge at a final dosage of 0.1 mL was performed and the patient was monitored for allergic and other adverse drug reactions, which did not occur. At the time of writing this case report, the patient has been maintained on Norditropin FlexPro® 0.1 mL and has not experienced any adverse reactions, including recurrent skin eruptions.The case presented is the first to describe a patient who successfully tolerated a graded dose challenge of an adult patient to GH replacement therapy (as Norditropin®) under supervision in an intensive care unit, whereas prior to reporting of this case, a graded dose challenge to GH replacement therapy had only been successfully performed in a child using another formulation of somatotropin (Humatrope®). Hence, this case lends support that graded dose challenge with somatotropin analogs may be considered for patients with isolated GH deficiency such as in the case presented here.

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Section: Bag# Step Concentrationmentioning

confidence: 99%

Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge

Mann¹,

Caruana²,

Luo³

et al. 2022

Cureus

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“…Drug desensitization is a procedure that allows temporary tolerance of pharmacologic agents in patients with a known or suspected hypersensitivity reaction [ 10 ], therefore, allowing patients to safely receive a drug continuously for the recommended time of treatment [ 11 ]. IgE-mediated hypersensitivity reactions can range from mild pruritus, vomiting, nasal congestion, pharyngeal pruritus, tingling of the lips, and urticaria, to more life-threatening systemic anaphylactic reactions requiring hospitalization and intubation [ 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…IgE-mediated hypersensitivity reactions can range from mild pruritus, vomiting, nasal congestion, pharyngeal pruritus, tingling of the lips, and urticaria, to more life-threatening systemic anaphylactic reactions requiring hospitalization and intubation [ 8 , 12 ]. Importantly, the tolerance is temporary; once the patient stops taking the drug and it is completely eliminated from the circulation, the hypersensitivity will return [ 11 ]. Therefore, maintaining a state of desensitization would require the continuous presence of the drug in the patient’s body through regular dosing, with no missed doses [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, the tolerance is temporary; once the patient stops taking the drug and it is completely eliminated from the circulation, the hypersensitivity will return [ 11 ]. Therefore, maintaining a state of desensitization would require the continuous presence of the drug in the patient’s body through regular dosing, with no missed doses [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Oral Metronidazole Desensitization for Immunoglobulin E (IgE)-Mediated Hypersensitivity

Hollis¹,

Mlauzi²,

Ashton

2022

Cureus

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Low efficacy has been reported for the treatment of Trichomonas vaginalis with antimicrobial agents other than the 5-nitroimidazole class. Patients with immunoglobulin E (IgE)-mediated hypersensitivity reactions to drugs in this class, including metronidazole and tinidazole, may benefit from a desensitization treatment. We present two patients with past medical histories of IgE-mediated hypersensitivity reactions to metronidazole who were successfully treated with metronidazole using a modified protocol. The first patient was a 39-year-old female diagnosed with trichomoniasis who had a previous reaction to metronidazole characterized by urticaria and pruritus. The second patient was a 53-year-old female who had a history of untreated trichomoniasis due to a previous anaphylactic reaction to metronidazole. Both patients were successfully treated in the intensive care unit (ICU) without signs and symptoms of the reaction. Physicians may use a desensitization protocol for patients with a presumed IgE-mediated hypersensitivity when only the 5-nitroimidazole class is efficacious for the treatment of trichomoniasis.

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Drug Desensitization in Immediate-Type Hypersensitivity

Cited by 2 publications

References 88 publications

Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge

Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge

Oral Metronidazole Desensitization for Immunoglobulin E (IgE)-Mediated Hypersensitivity

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