Successful desensitization to high-dose methotrexate after systemic anaphylaxis

Anaphylaxis during the first course of high-dose methotrexate: a case report and literature review

“…Most of the reviewed cases occurred after repeated courses of MTX 6–15 . In contrast, only five patients (four from PubMed search plus ours) experienced anaphylactic reaction during the first MTX infusion, 2–5 as shown by our case and the literature search. Davis et al.…”

“…Although this treatment generally has a favourable benefit/risk profile, 1 serious adverse drug reactions (ADRs) cannot be excluded and/or easily prevented. Hypersensitivity reactions to MTX are rare, and few cases of anaphylactic reactions to the first dose of MTX are documented in the current medical literature 2–5 . Herein, we report a life‐threatening adverse event that occurred during the first course of MTX therapy, likely due to an immune‐mediated mechanism.…”

“…Davis et al. 4 and Ozguven et al. 5 reported anaphylaxis during the first course of high‐dose MTX for osteosarcoma treatment.…”

Management and successful desensitization in methotrexate‐induced anaphylaxis

“…In this report, the patient was successfully rechallenged with the same dose of methotrexate after receiving pre‐treatment with oral and intravenous corticosteroids and intravenous antihistamines (diphenyhydramine and ranitidine). Since this report, several desensitization protocols have been described by several authors 3, 4, 8, 11 (Table I). We readministered MTX using a 24‐hr desensitization protocol that was previously used successfully by two of these authors 3, 8.…”

“…Its major adverse effects are mucositis, renal and hepatic damage. Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, have also been occasionally reported 1–14.…”