Anaphylactic Reaction to Liposomal Amphotericin (Ambisome)

Features of complement activation-related pseudoallergy to liposomes with different surface charge and PEGylation: Comparison of the porcine and rat responses

“…AmBisome, a highly charged nonPEGylated liposome with a phospholipid surface unmodified by PEG, which is widely used in the treatment of systemic fungal infections [30][31][32][33][34][35][36], and is known to cause anaphylactic reactions in man [37], was stronger inducer of CARPA in both species than its identically sized (~100 nm), uncharged PEGylated counterpart, Chol-PEG liposomes. PEGylated liposomes are widely used in the treatment of cancer (e.g.…”

Complement activation-related pseudoallergy: A new class of drug-induced acute immune toxicity

“…At present, more than a dozen liposomal drugs are in advanced clinical trials, or already used in patients mainly for anticancer and antifungal applications (Szebeni, 2004a,b). Out of the marketed liposomal drugs Doxil (Caelyx) (Uziely et al, 1995;Alberts and Garcia, 1997;Dezube, 1996;Gabizon and Martin, 1997;Gabizon and Muggia, 1998;Chanan-Khan et al, 2003), AmBisome (Levine et al, 1991;Laing et al, 1994;Ringdén et al, 1994;de Marie, 1996;Schneider et al, 1998), Abelcet (de Marie, 1996, Amphocil (de Marie, 1996) and DaunoXome (Cabriales et al, 1998;Eckardt et al, 1994;Fossa et al, 1998;Gill et al, 1995Gill et al, , 1996Girard et al, 1996;Guaglianone et al, 1994;MoneyKyrle et al, 1993;Richardson et al, 1997) have been reported to cause HSRs with symptoms corresponding to CARPA (Table 1). The frequency of HSRs to liposomal drugs shows large variation between 3 and 45% (Szebeni, 1998(Szebeni, , 2001.…”

Cardiopulmonary hemodynamic responses to the small injection of hemoglobin vesicles (artificial oxygen carriers) in miniature pigs

“…Thereby, it enhances the targeting of incorporated drugs to the site of a disease. However, the so‐called injection reaction is clarified as clinical experiences accumulate, such as dyspensa, tachypenia, tachycardia, hypotension and hypertension, chest pain, and back pain 2–5. It is believed that these hypertensive reactions are a consequence of complement activation: so‐called complement activation‐related pseudoallergy 4.…”

“…However, the so-called injection reaction is clarified as clinical experiences accumulate, such as dyspensa, tachypenia, tachycardia, hypotension and hypertension, chest pain, and back pain. [2][3][4][5] It is believed that these hypertensive reactions are a consequence of complement activation: so-called complement activation-related pseudoallergy. 4 Reportedly, pigs respond reproducibly and significantly to the injection of liposomal products, especially those containing phosphatidylglycerol (PG), resulting in anaphylactoid reactions and cardiopulmonary disorders, manifested as systemic and pulmonary hypertension, increased vascular resistance, decreased cardiac output (CO), thrombocytopenia, tachycardia, and so forth.…”