Successful desensitization for cytarabine induced anaphylaxis

Hyun Woo Lee; Jae Yong Park; Joon Ho Moon; Kyung Taek Park; Han-Ki Park; Hye-Ryun Kang

doi:10.4168/aard.2014.2.5.394

Journal List > Allergy Asthma Respir Dis > v.2(5) > 1059065

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Lee, Park, Moon, Park, Park, and Kang: Successful desensitization for cytarabine induced anaphylaxis

Case Report

Allergy, Asthma & Respiratory Disease 2014; 2(5): 394-397.

Published online: 28 November 2014

DOI: https://doi.org/10.4168/aard.2014.2.5.394

Successful desensitization for cytarabine induced anaphylaxis

Hyun Woo Lee¹, Jae Yong Park¹, Joon Ho Moon¹, Kyung Taek Park¹, Han-Ki Park^1,^2,³, Hye-Ryun Kang^1,^2,³

¹Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

²Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

³Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea.

Correspondence to: Hye-Ryun Kang. Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2072-0820, Fax: +82-2742-3291, helenmed@snu.ac.kr

Received 26 June 2014 Revised 11 August 2014 Accepted 11 August 2014

(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/3.0/).

Abstract

Cytarabine is a very important chemotherapeutic agent for leukemia and lymphoma patients and is prescribed more frequently than before. Cytarabine-induced delayed-onset hypersensitivity may rarely present as non-IgE mediated anaphylaxis. However, we do not know yet whether desensitization therapy in adults may be effective in cytarabine-induced delayed-onset anaphylaxis. A 78-year-old woman who was diagnosed with acute myeloblastic leukemia had chemotherapy including cytarabine. In spite of premedication with hydrocortisone and chlorpheniramine, the patient had anaphylaxis a few hours after cytarabine infusion. We decided to perform desensitization therapy. After desensitization therapy using a newly designed protocol, the patient was tolerable to cytarabine infusion without hypotension or high fever. Desensitization therapy was successfully performed on an adult patient with delayed-onset anaphylaxis caused by cytarabine.

Keywords: Anaphylaxis, Cytarabine, Immunologic desensitization

Figures and Tables

Fig. 1

Hypotension and peak fever over 39℃ occurred after cytarabine infusion, however, vanished after desensitization. SBP, systolic blood pressure.

Table 1

A desensitization protocol consisting of 4 bottles of 10-fold increasing solutions (A, B, C, and D)

Total target dose of cytarabine=1,400 mg.

DW, stands for dextrose 5% in distilled water.

Table 2

Eleven steps used in the present case of the cytarabine syndrome

Notes

This research was supported by a grant from Ministry of Food and Drug Safety to operation of the Regional Pharmacovigilance Center in 2014.

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