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Lee, Lee, Kim, Kang, Lee, Chung, Oh, and Kang: A case of rapid desensitization for rituximab-induced delayed hypersensitivity reaction
Case Report

Allergy Asthma Respir Dis 2019;7(2):109-112.

Published online: 12 April 2019

DOI: https://doi.org/10.4168/aard.2019.7.2.109

A case of rapid desensitization for rituximab-induced delayed hypersensitivity reaction

Su Ho Lee1, Jae Ha Lee2, Nam Hee Kim2, Dong Yoon Kang2, 3, Ju Yeun Lee4, Soo Jie Chung5, Ji Hyun Oh5, Hye-Ryun Kang2, 5

1Wonkwang University College of Pharmacy, Iksan

2Drug Safety Monitoring Center Seoul National University Hospital, Seoul Korea

3Department of Preventive Medicine, Seoul National University College of Medicine, Seoul Korea

4Seoul National University College of Pharmacy, Seoul Korea

5Department of Internal Medicine, Seoul National University College of Medicine, Seoul Korea

Correspondence to: Hye-Ryun Kang https://orcid.org/0000-0002-2317-4201 Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0820, Fax: +82-2-742-3291, E-mail: helenmed@snu.ac.kr

Received 26 June 2018       Revised 18 August 2018       Accepted 30 August 2018

Copyright © 2019 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

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/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rituximab is a monoclonal antibody used for the treatment of B-cell malignancies, including diffuse large B-cell lymphoma. Infusion-related hypersensitivity reactions to rituximab is well known, and delayed hypersensitivity reactions to rituximab are also reported. Desensitization is commonly used to prevent immediate hypersensitivity reactions, but recently there have been cases of successful desensitization therapy for delayed hypersensitivity reactions. A 66-year-old patient who underwent rituximab treatment for diffuse large B-cell lymphoma showed repeated rituximab-induced delayed hypersensitivity reactions with whole body rashes. Intravenous rapid desensitization was performed by using a 1-bottle, 11-step protocol for 6 cycles and thereafter hypersensitivity reaction did not recur. We herein reported a case of delayed hypersensitivity reaction caused by rituximab, which was successfully desensitized using our 11-step protocol.

Keywords: Rituximab, Delayed hypersensitivity, Immunologic desensitization

References

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Fig. 1.
Clinical feature of rituximab-induced delayed hypersensitivity.
aard-7-109f1.tif
Table 1.
A 1 bag desensitization protocol used for a case of delayed hypersensitivity to rituximab
Concentration (mg/mL) Rate (mL/hr) Minute Dose (mg) Volume (mL)
3.10345 0.1 15 0.0776 0.025
3.10345 0.2 15 0.1552 0.05
3.10345 0.5 15 0.3879 0.13
3.10345 1.2 15 0.9310 0.30
3.10345 2.5 15 1.9397 0.63
3.10345 5 15 3.8793 1.3
3.10345 10 15 7.7586 2.5
3.10345 20 15 15.5172 5.0
3.10345 40 15 31.0345 10.0
3.10345 80 15 62.0690 20.0
3.10345 130 78.0 524.1724 168.9
Total   213.0 675.00 217.5
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