Successful Phenobarbital Desensitization After DRESS Reaction in the Management of Refractory Status Epilepticus

Abstract

Graded desensitization may be an option to minimize recurrence of DRESS in patients where avoidance of the offending agent is not possible.

Tolerance Induction to Antituberculosis Drugs in a Patient With Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis Overlap

“…11 Desensitization in SJS or in TEN has been described as an absolute contraindication by some authors, 7 but in more recent times, cases of desensitization in severe reactions have been reported: Minor in 2012 with a successful desensitization protocol in a SJS to veramufanib, 12 Witcher in 2018 with a successful desensitization in a Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome to phenobarbital, Thong in 2014 with a successful desensitization rechallenge for anti-TB drug allergy in 2 patients with SJS, and Siripassorn in 2018 with a success rate of 62% of drug desensitization in patients with severe allergic reactions demonstrating the myth of not being able to desensitize or induce tolerance in severe adverse reactions like SJS, TEN, DRESS syndrome, and others hypersensitivity syndromes. [12][13][14][15] However, given the need for anti-TB treatment and the absence of first-line treatment alternatives in this patient, it was necessary to propose a new tolerance induction scheme for rifampin and isoniazid. [16][17][18] Selection of the specific desensitization or tolerance induction protocol will depend on the patient's conditions, the presence of atopy, comorbidities, and the type of adverse reaction presented.…”

Hypersensitivity to monoclonal antibodies used for cancer and inflammatory or connective tissue diseases

“…33 One report documents successful desensitization to the BRAF inhibitor vemurafenib for melanoma, 34 but to our knowledge there are no reports of successful desensitization to a TmAb to circumvent a type IV reaction. In contrast to TmAbs, which are administered parenterally to avoid proteolytic degradation in the digestive system, those drugs that cause type IV reactions for which desensitization was achieved are given orally, [35][36][37] which may account in part for the success of the desensitizations reported. Therefore, we advocate strict avoidance of any TmAb implicated in a type IV reaction and do not attempt desensitization.…”