Successful desensitization to fluconazole induced delayed hypersensitivity: A case report

Heo, Yeonjeong; Park, Seung-Woo; Lee, Kyu-Sun; Kang, Hye-Ryun; Kwon, Jae-Woo

doi:10.4168/aard.2018.6.1.68

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…Increased expression of interleukin-10 (IL-10), IL-35, CD4 + CD25 + , and CD4 + CD25 + FoxP3 + after desensitization also suggested the importance of regulatory T cells in delayedtype reactions [19,21,22] . Successful desensitization has also been reported in delayed-type hypersensitivity reactions to antituberculosis drugs and trimethoprimsulfamethoxazole and fluconazole [23][24][25] .…”

Section: Immunological Mechanismsmentioning

confidence: 96%

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Desensitization for the Prevention of Drug Hypersensitivity

Yun,

Jeong,

Kang

2023

jmds

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Drug desensitization is a treatment strategy for patients with hypersensitivity to essential drugs without alternatives. The gradual increase in the drug dosage from low doses to therapeutic levels induces a transient immune tolerance to the culprit drug. Although desensitization has traditionally been recommended for IgE-mediated immediate hypersensitivity, this indication has recently been expanded to include non-IgE-mediated immediate responses, nonimmunological responses, and T-cell mediated delayed hypersensitivity reactions. Although the exact mechanism behind desensitization remains unclear, the process is thought to attenuate various intracellular signals in target cells through the high-affinity IgE receptor (FcɛRI) internalization, alteration in signaling pathways in mast cells and basophils, reduction in Ca2+ influx, and production of anti-drug IgG4 blocking antibody. Desensitization can be used for the safe administration of anti-neoplastic agents, antibiotics, aspirin, and nonsteroidal anti-inflammatory drugs. Various desensitization protocols have been proposed for each drug. The optimization of drug concentration, target dosage, administration interval, and route of administration is key to successful desensitization. In addition, the desensitization protocol should be individualized for each patient with consideration of the severity of the initial hypersensitivity response, the characteristics of the culprit drug, and the nature of the breakthrough reactions.

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Section: Immunological Mechanismsmentioning

confidence: 96%

“…More recently, successful desensitization has been reported in hypersensitivity reactions associated with antifungal agents (amphotericin B, fluconazole, itraconazole, voriconazole, micafungin) and antiviral agents (acyclovir, valganciclovir, ribavirin, nevirapine) [53][54][55][56][57][58][59] .…”

Section: Antibioticsmentioning

confidence: 99%

Desensitization for the Prevention of Drug Hypersensitivity

Yun,

Jeong,

Kang

2023

jmds

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“…Successful desensitization to other antimicrobials has also been reported for antifungals, such as amphotericin B, fluconazole, itraconazole, voriconazole, and micafungin, and for antivirals, such as acyclovir, valganciclovir, ribavirin, and nevirapine [62][63][64][65][66][67][68][69].…”

Section: Antibioticsmentioning

confidence: 99%

Desensitization for the prevention of drug hypersensitivity reactions

Kang

Seo

Kang

2022

Korean J Intern Med

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Drug desensitization is the temporary induction of tolerance to a sensitized drug by administering slow increments of the drug, starting from a very small amount to a full therapeutic dose. It can be used as a therapeutic strategy for patients with drug hypersensitivity when no comparable alternatives are available. Desensitization has been recommended for immunoglobulin E (IgE)-mediated immediate hypersensitivity; however, its indications have recently been expanded to include non-IgE-mediated, non-immunological, or delayed T cell-mediated reactions. Currently, the mechanism of desensitization is not fully understood. However, the attenuation of various intracellular signals in target cells is an area of active research, such as high-affinity IgE receptor (FcεRI) internalization, anti-drug IgG4 blocking antibody, altered signaling pathways in mast cells and basophils, and reduced Ca 2+ influx. Agents commonly requiring desensitization include antineoplastic agents, antibiotics, antituberculous agents, and aspirin/nonsteroidal antiinflammatory drugs. Various desensitization protocols (rapid or slow, multi-bag or one-bag, with different target doses) have been proposed for each drug. An appropriate protocol should be selected with the appropriate concentration, dosage, dosing interval, and route of administration. In addition, the protocol should be adjusted with consideration of the severity of the initial reaction, the characteristics of the drug itself, as well as the frequency, pattern, and degree of breakthrough reactions.

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A case of rapid desensitization for rituximab-induced delayed hypersensitivity reaction

Lee

Kim

et al. 2019

Allergy Asthma Respir Dis

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Rituximab is a monoclonal antibody used for the treatment of B-cell malignancies, including diffuse large B-cell lymphoma. Infusion-related hypersensitivity reactions to rituximab is well known, and delayed hypersensitivity reactions to rituximab are also reported. Desensitization is commonly used to prevent immediate hypersensitivity reactions, but recently there have been cases of successful desensitization therapy for delayed hypersensitivity reactions. A 66-year-old patient who underwent rituximab treatment for diffuse large B-cell lymphoma showed repeated rituximab-induced delayed hypersensitivity reactions with whole body rashes. Intravenous rapid desensitization was performed by using a 1-bottle, 11-step protocol for 6 cycles and thereafter hypersensitivity reaction did not recur. We herein reported a case of delayed hypersensitivity reaction caused by rituximab, which was successfully desensitized using our 11-step protocol.

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Successful desensitization to fluconazole induced delayed hypersensitivity: A case report

Cited by 4 publications

References 17 publications

Desensitization for the Prevention of Drug Hypersensitivity

Desensitization for the Prevention of Drug Hypersensitivity

Desensitization for the prevention of drug hypersensitivity reactions

A case of rapid desensitization for rituximab-induced delayed hypersensitivity reaction

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