Successful desensitization of a patient with albumin hypersensitivity

So Yoon Jung; Yun Jung Choi; Seung Hyun Lee; Hye Ryun Kang; Dong In Suh

doi:10.4168/aard.2017.5.2.117

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Jung, Choi, Lee, Kang, and Suh: Successful desensitization of a patient with albumin hypersensitivity

Case Report

Allergy, Asthma & Respiratory Disease 2017; 5(2): 117-120.

Published online: 31 March 2017

DOI: https://doi.org/10.4168/aard.2017.5.2.117

Successful desensitization of a patient with albumin hypersensitivity

So Yoon Jung¹, Yun Jung Choi¹, Seung Hyun Lee², Hye Ryun Kang^3,⁴, Dong In Suh¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

²Department of Pediatric Pharmacy, Seoul National University Children's Hospital, Seoul, Korea.

³Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁴Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea.

Correspondence to: Dong In Suh. Department of Pediatrics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-3625, Fax: +82-2-2072-3971, dongins0@snu.ac.kr

Received 11 August 2016 Revised 14 October 2016 Accepted 17 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

There have been few cases of albumin hypersensitivity reported, and there is limited information on this condition. When a patient is anaphylactic to a certain drug and no alternative drug is available to treat the underlying condition, desensitization is a reasonable option and can be performed successfully to treat the patient. A standard 12-step, 3-solution rapid desensitization protocol allows the safe readministration of a medication after certain types of immediate hypersensitivity. However, we demonstrated that a new 10-step, 1-solution desensitization protocol using antihistamine and leukotriene receptor antagonist as premedications, which was effective and safe in a patient with hypersensitivity. We report a 13-year-old boy with Gorham-stout syndrome who was presented with newly acquired albumin anaphylaxis and successfully treated with the 10-step rapid drug desensitization protocol.

Keywords: Drug hypersensitivity syndrome, Anaphylaxis, Immunologic desensitization

Figures and Tables

Fig. 1

Serial X-ray images show the gradual increase in the pleural fluid of both lung fields in 2010 (A), in 2012 (B), in February 2015 (C), and in December 2015 (D).

Fig. 2

Hypotension and desaturation occurred after albumin injections, however, vanished after desensitization. LTRA, Leukotriene receptor antagonist. ♦ indicates symptoms of flushing or rash.

Table 1

Rapid desensitization protocol which was applied to this case

Concentration (mg/mL)	Rate (mL/hr)	Duration (min)	Volume (mL)	Dose (mg)	Cumulative dose (mg)
20.0	0.1	15.0	0.025	0.5	0.5
20.0	0.2	15.0	0.050	1.0	1.5
20.0	0.4	15.0	0.100	2.0	3.5
20.0	0.8	15.0	0.200	4.0	7.5
20.0	1.2	15.0	0.300	6.0	13.5
20.0	2.5	15.0	0.625	12.5	26.0
20.0	5.0	15.0	1.250	25.0	51.0
20.0	10.0	15.0	2.500	50.0	101.0
20.0	20.0	15.0	5.000	100.0	201.0
20.0	30.0	179.9	89.95	1,799.0	2,000.0
Total	-	314.9	100.00	2,000.0	-

This new protocol needs only 1 kind of concentration of drug comparing with previous protocol which needed at least 3 kinds of gradual concentrated drug.

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ORCID iDs: Dong In Suh
https://orcid.org/http://orcid.org/0000-0002-7817-8728
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