Life‐threatening anaphylaxis to leuprorelin acetate depot: Case report and review of the literature

Abstract

Abbreviations & Acronyms DLST = drug-lymphocyte stimulation test DTX = docetaxel EMP = estramustine phosphate GA = goserelin acetate GnRHa = gonadotropinreleasing hormone analog LA = leuprorelin acetate PLA = polylactic acid PLGA = polylactic and glycolic acids PSA = prostate-specific antigen SI = stimulation index SpO2 = pulse oximetry Abstract: Gonadotropin-releasing hormone analog depots have been widely used for a variety of diseases including prostate cancer, breast cancer, endometriosis, uterine leiomyomas, and central precocious puberty. Most of the side/adverse effects of gonadotropin-releasing hormone analog depots, such as leuprorelin acetate depot, are related to hypotestosteronism in males. Anaphylaxis to gonadotropin-releasing hormone analog depot is extremely rare. We present the first case report of a Japanese man who developed anaphylaxis to leuprorelin acetate depot during the treatment of metastatic prostate cancer and recovered successfully by conservative treatment. A drug-lymphocyte stimulation test showed that not only leuprorelin acetate itself, but also its vehicle polylactic and glycolic acids, might be responsible for the anaphylaxis to leuprorelin acetate depot. Because anaphylaxis can be lethal, the present case suggests that one should bear in mind the possibility of anaphylaxis in all patients who receive gonadotropin-releasing hormone analog depot and monitor such patients carefully.

MANAGEMENT OF ENDOCRINE DISEASE: Long-term outcomes of the treatment of central precocious puberty

“…GnRHa is generally safe and well tolerated. Local events such as bruising, pain, injection reactions, and sterile abscesses are the most common side effects, followed by minor menopausal symptoms -that is, hot flushes, headaches, and nausea (7) -while anaphylaxis is extremely rare (10).…”

A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature

“…Of the anaphylaxis cases reported in the adult patients, four pertained to LA and one pertained to GA, whereas anaphylaxis reported in the pediatric case both pertained to LA and GA (1,2,(12)(13)(14)(15). The manifesting reaction in these cases was in the form of skin reactions only in two patients (1,13).…”

“…In our patient, we detected sensitivity to both LA and TA but were unable to identify to which of the medicinal products formulated with these agents the patient was sensitive. We consider that the source was polylactic and glycolic acid, which were contained in both the drugs and were reported as allergens by Fujisaki et al (1).…”

“…Local effects of GnRH analogues including induration and aseptic abscess are generally well known. Rare adverse effects of the agents on the nervous system, skin, gastrointestinal tract, and cardiovascular system have also been reported (1)(2)(3)(4)(5)(6)(7).…”

“…Allergic reactions are not limited to active substances but may also develop against the adjuvants or preservatives contained in the medicinal product. Drug lymphocyte stimulation test (DLST), radioallergosorbent test, and skin tests are used to determine the causative allergen (1,9).…”