Amphotericin B: Emergency challenge in a neutropenic, asthmatic patient with fungal sepsis

Immediate hypersensitivity reaction following liposomal amphotericin-B (AmBisome) infusion

“… 2 The immune effects of liposomal carrying agents (therapeutic liposomes) have not been well studied despite an interaction of phospholipid bilayers with the immune system having been described. 3 , 4 Patients who experience hypersensitivity reactions to liposomal amphotericin have usually not received it previously and thus could not have been sensitised to it. This suggests that mechanisms other than a type I hypersensitivity reaction are involved in these cases.…”

“…This suggests that mechanisms other than a type I hypersensitivity reaction are involved in these cases. 4 , 5 Liposomes and lipid excipient-based drugs are generally recognised by the immune system as foreign, resulting in a variety of adverse immune phenomena. One of them is complement activation, the cause, or major contributing factor to, a hypersensitivity syndrome.…”

Antifungal hypersensitivity reactions and cross-reactivity patterns

“…When substitution with alternative antifungal medications is not an option and the initial reported reaction is an immediate reaction (other than an infusion reaction) or a delayed reaction limited to mild-moderate rash alone (i.e. not systemic reaction or organ involvement) successful desensitization has been described with various agents such as azole -oral itraconazole [18], oral fluconazole [15,17,19,86], oral voriconazole [95], intravenous voriconazole [11] and polyene antimycotic macrolides -intravenous liposomal amphotericin B [56][57][58].…”

“…Side effect reported following amphotericin B use include fever, rigors, headache, nausea, emesis, bronchospasm, nephrotoxicity, phlebitis, hypokalemia, anemia, abnormal renal function, and renal tubular acidosis [55 & ]. Some of these adverse reactions are associated with an infusion-related reaction but the differential diagnosis of anaphylaxis needs to be considered, as reported in the literature [56][57][58] -Table 1. IgE-mediated reactions are rarely associated with amphotericin B [59].…”