Protocol for Desensitization to Trastuzumab in a Patient With Anaphylaxis and Stage IV Breast Cancer: A Case Report

Lira-Quezada, Cindy Elizabeth de; Villarreal-González, Rosalaura Virginia; González‐Díaz, Sandra Nora; Acuña-Ortega, Natalhie

doi:10.18176/jiaci.0558

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…HSR are also frequent during monoclonal antibody therapy and rapid desensitization procedures proved to be effective and safe for rituximab [13,37], tocilizumab [38], infliximab [39], trastuzumab [40]. As for, iron therapy, rapid desensitization schedules were published by our group and others [41,42].…”

Section: Discussionmentioning

confidence: 99%

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Novel approach to idursulfase and laronidase desensitization in type 2 and type 1 S mucopolysaccharidosis (MPS)

Spataro

Viggiani

Macchia

et al. 2022

Orphanet J Rare Dis

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Background: Idursulfase and laronidase are drugs used to treat Hunter syndrome (mucopolysaccharidosis type 2) and Scheie syndrome (mucopolysaccharidosis type 1 S), respectively. These are rare lysosomal storage disorders, leading to accumulation of glycosaminoglycans within lysosomes. Failure of early recognition of the disease and/or delay in starting the appropriate treatment result in severe clinical impairment and death. For almost 20 years, enzyme replacement therapy with recombinant proteins has represented the first line therapeutic option. However, administration of idursulfase and laronidase is associated with infusion-related hypersensitivity reactions, in approx. 20% of patients. In these patients, rapid desensitization by intravenous administration protocols has been used in order to avoid treatment discontinuation. This approach proved effective and safe. However, long-term tolerance could not be achieved. Thus, we decided to combine rapid desensitization with allergen immunotherapy-like desensitization. Results: Two patients with Hunter syndrome and one patient with Scheie syndrome developed severe allergy to idursulfase and laronidase, respectively, preventing them from continuing the otherwise indispensable therapy. In all three patients, the possible IgE-mediated nature of the reactions suffered was suggested by positive skin tests with the two enzymes, respectively. By devising 12-step, 3-dilution rapid desensitization protocols, we resumed the enzyme replacement therapy. However, the prolonged time required for administration (a not negligible pitfall, since therapy should be given weekly for life) and the persistent occurrence of reactions (mild but still requiring anti-allergic medication at full dosage) led us to combine rapid desensitization with a compact 11-step, 24-day allergen immunotherapy-like desensitization protocol. Thus, idursulfase and laronidase were injected subcutaneously, with a 500-fold increase from step 1 to step 11 for idursulfase and a 222-fold increase for laronidase. This strategy led to restoration of long-term tolerance, allowing weekly intravenous therapy administration under standard conditions, according to the manufacturer instructions, in the absence of side effects and with only precautionary low-dose premedication. Conclusion: Rapid desensitization is a suitable and safe option in the case of idursulfase and laronidase allergy. Combination with subcutaneous allergen immunotherapy-like desensitization afforded restoration of enzyme replacement therapy given by the normal administration schedule, by inducing sustained tolerance.

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Section: Discussionmentioning

confidence: 99%

“…Rapid desensitization procedures by intravenous infusion have proved effective and safe and have been employed in the management of allergy to a variety of drugs, such as chemotherapeutic drugs, antibiotics, monoclonal antibodies, iron therapy, etc. [33][34][35][36][37][38][39][40][41][42][43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Novel approach to idursulfase and laronidase desensitization in type 2 and type 1 S mucopolysaccharidosis (MPS)

Spataro

Viggiani

Macchia

et al. 2022

Orphanet J Rare Dis

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“…In case of the patient described, the hypersensitivity reactions occurred with re-exposure to trastuzumab after a prolonged course of therapy (11 cycles), with good tolerability, as occurred in the studies by Melamed, De Lira-Quezada et al, in which they presented a protocol supported by a similar magnitude. Our experience has allowed us to demonstrate the safety of using an optimised desensitisation protocol for the patient and nursing staff [11][12][13]. The eleven-step process was well tolerated and the patient was able to continue with her standard HER-2 breast cancer treatment.…”

Section: Discussionmentioning

confidence: 99%

Trastuzumab desensitization: A case report

Tejada E

2023

Open J Clin Med Case Rep

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“…It is well known that desensitization by expert allergists has emerged as a powerful tool that is safe and effective to maintain treatment in reacting patients with monoclonal antibodies [3,9].It has been described that in case of CRRs endotype/phenotype a desensitization protocol could be consider as a method of drug re-introduction [3]. J Investig Allergol Clin Immunol 2021; Vol.…”

mentioning

confidence: 99%

Successful Desensitization to Daratumumab After a Severe Life-threatening Reaction in a Patient With Refractory Multiple Myeloma

Carrón-Herrero¹,

Solano-Solares²,

Rita³

et al. 2021

J Investig Allergol Clin Immunol

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Protocol for Desensitization to Trastuzumab in a Patient With Anaphylaxis and Stage IV Breast Cancer: A Case Report

Cited by 4 publications

References 10 publications

Novel approach to idursulfase and laronidase desensitization in type 2 and type 1 S mucopolysaccharidosis (MPS)

Novel approach to idursulfase and laronidase desensitization in type 2 and type 1 S mucopolysaccharidosis (MPS)

Trastuzumab desensitization: A case report

Successful Desensitization to Daratumumab After a Severe Life-threatening Reaction in a Patient With Refractory Multiple Myeloma

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