Recombinant Human Hyaluronidase-Enabled Subcutaneous Pediatric Rehydration

Abstract

rHuPH20-facilitated subcutaneous hydration seems to be safe and effective for young children with mild/moderate dehydration. Subcutaneous access is achieved easily, and the procedure is well accepted by clinicians and parents.

Recombinant human hyaluronidase-facilitated subcutaneous infusion of human immunoglobulins for primary immunodeficiency

“…It has been shown to be safe and effective in enhancing dispersion and absorption of fluids and drugs administered subcutaneously, and received approval by the Food and Drug Administration in the United States. [16][17][18] Preclinical studies have found that rHuPH20 is short acting, with a half-life of <30 minutes, and is undetectable in plasma after administration at the doses used to facilitate SC infusions. 14 A phase I/II study of facilitated subcutaneous administration of Immune Globulin Infusion 10% (Human) with rHuPH20 (IGHy) in 11 patients with primary immunodeficiency (PI) showed the feasibility of infusing monthly doses of up to 618 mL of IgG 10% solution in a single SC site with bioavailability that approximated that of IGIV.…”

Use of Hyaluronidase for Pharmacokinetic Increase in Bioavailability of Intracutaneously Applied Substances

“…In earlier publications, the influence of HAase on the distribution behaviour of radioactive tracers has been studied [52,53]. In addition, there are data about the use of HAase as pre-treatment to infusions that are given as subcutaneous fluid substitution for the dehydrated patient that cannot be put on an intravenous drip [54,55]. Especially rHuPH20 was described as enabling a fivefold faster subcutaneous liquid absorption, which makes it therefore possible to adapt this technique for paediatrics [55,56,57].…”

“…In addition, there are data about the use of HAase as pre-treatment to infusions that are given as subcutaneous fluid substitution for the dehydrated patient that cannot be put on an intravenous drip [54,55]. Especially rHuPH20 was described as enabling a fivefold faster subcutaneous liquid absorption, which makes it therefore possible to adapt this technique for paediatrics [55,56,57]. Other authors are more critical of this application since data do not show explicit benefits compared to other rehydration techniques [58].…”

Epidural Lysis of Adhesions: Percutaneous and Endoscopic Techniques

“…Some potential risk arises as some patients may be allergic to these preparations, particularly the puri fi ed animal preparation which may have limited their use especially in the pediatric population [ 27,28 ] . The use of human recombinant hyaluronidase is less likely to cause allergic reaction as it has up to 100 times greater purity than the reference standard, animal-derived formulation based on enzymatic activity [ 29,30 ] . Reported allergic reactions include erythema at the site to urticaria and angioedema in those patients receiving human recombinant hyaluronidase (less than 0.1 %) [ 31 ] .…”