Cyclophosphamide desensitization in patients with severe hypersensitivity reactions to bendamustine

2019 ◽  
Vol 26 (4) ◽  
pp. 982-985 ◽  
Author(s):  
Bradley Figgins ◽  
Brian Primeaux ◽  
Brandon R Shank ◽  
Sheree E Chen ◽  
Donna M Weber ◽  
...  
Keyword(s):  
Case Report ◽  
Adverse Effects ◽  
Nitrogen Mustard ◽  
Interdisciplinary Approach ◽  
Hematologic Malignancies ◽  
Hypersensitivity Reactions ◽  
Related Drug ◽  
Desensitization Protocol ◽  
Treatment Alternatives ◽  
To Receive

Introduction Cyclophosphamide is a nitrogen mustard alkylator employed in the treatment of many malignancies and autoimmune disorders. Despite reports of cyclophosphamide hypersensitivity ranging from rash to anaphylaxis, no cases of desensitization have been reported in the oncologic setting. Case report We report a cyclophosphamide desensitization protocol used for two patients who experienced severe hypersensitivity to bendamustine, a structurally related drug with potential cross immunogenicity. Management and outcome An interdisciplinary approach including immunologist, oncologist, and clinical pharmacists resulted in the development of a multi-step desensitization protocol for cyclophosphamide. The desensitization protocol described enabled the safe administration of cyclophosphamide for the two patients with limited treatment alternatives. Discussion To the authors' knowledge, this is the first report of cyclophosphamide desensitization in the oncologic setting. Two patients with advanced hematologic malignancies were able to receive cyclophosphamide with minimal adverse effects, despite experiencing previous severe hypersensitivity to another nitrogen mustard analogue.

scholarly journals Management and Successful Desensitization in a Patient with Abatacept-Induced Anaphylaxis

2021 ◽  
Vol 19 (1) ◽  
pp. 46-49
Author(s):  
Ferda Bilgir ◽  
Gökhan Kabadayı ◽  
Servet Akar
Keyword(s):  
T Cell Activation ◽  
Cell Activation ◽  
Biological Agents ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Insufficient Response ◽  
Desensitization Protocol ◽  
To Receive

ABSTRACT Abatacept is a fusion protein that blocks T cell activation. It is used in a variety of conditions including organ transplantation, immune deficiency, and autoimmune diseases. Even though abatacept-induced adverse events are observed, hypersensitivity reactions are rare. Desensitization protocols that can be implemented in the case of hypersensitivity reactions are present in the literature for many biological agents. However, a desensitization protocol for abatacept has not yet been established. Our patient, who was started on one of the biological agents, abatacept, for rheumatoid arthritis due to insufficient response to disease- modifying antirheumatic drugs, developed immediate hypersensitivity reaction with the first dose. Since it was planned to continue the treatment, abatacept desensitization was performed. The rapid desensitization protocol performed with prior premedication was successful and the patient was able to receive subsequent doses of abatacept using the same protocol. Keywords: Abatacept, anaphylaxis, desensitization

scholarly journals Disulfiram-like Reaction Involving Ceftriaxone in a Pediatric Patient

2018 ◽  
Vol 23 (2) ◽  
pp. 168-171 ◽  
Author(s):  
Stephen M. Small ◽  
Rachel S. Bacher ◽  
Sheridan A. Jost
Keyword(s):  
Case Report ◽  
Adverse Effects ◽  
Pediatric Patient ◽  
Asthma Exacerbation ◽  
Pediatric Patients ◽  
Community Acquired Pneumonia ◽  
Hypersensitivity Reactions ◽  
Potential Drug ◽  
Facial Flushing ◽  
Cephalosporin Antibiotics

Several medications have been shown to cause disulfiram-like reactions in patients concomitantly exposed to ethanol, including specific cephalosporin antibiotics that possess a methylthiotetrazole substituent. Within the cephalosporin class, there are few reports of disulfiram-like reactions with ceftriaxone. This case report is the first to involve a pediatric patient, and it describes a mild but likely disulfiram-like reaction manifesting as facial flushing in an 8-year-old male upon receiving a ceftriaxone infusion preceded by a dose of prednisolone elixir (5% ethanol by volume) for presumed community-acquired pneumonia thought to be complicated by an asthma exacerbation. The patient's flushing resolved with intravenous diphenhydramine, did not reappear, and was diagnosed as an allergy to ceftriaxone. Upon further evaluation, a hypersensitivity reaction was considered unlikely, and the allergy history was revised. The patient's antibiotic treatment was switched to azithromycin without steroids, and he had no further issues. This case suggests there is benefit in increased monitoring of pediatric patients receiving certain cephalosporins along with alcohol-containing medications, and it demonstrates how disulfiram reactions can easily be misinterpreted as hypersensitivity reactions. Aside from just alcohol-cephalosporin interactions, this case underscores the need for general vigilance when using alcohol-containing drug preparations in pediatric patients in an effort to prevent adverse effects and potential drug interactions.

scholarly journals Delayed-Type Hypersensitivity Reaction to Red Tattoo Ink Triggered by Ledipasvir/Sofosbuvir for Hepatitis C: A Case Report

2021 ◽  
pp. 379-383
Author(s):  
Meghan L. McPhie ◽  
Kevin Y.M. Ren ◽  
J. Michael Hendry ◽  
Sonja Molin ◽  
Thomas Herzinger
Keyword(s):  
Case Report ◽  
Hepatitis C ◽  
Adverse Effects ◽  
Hypersensitivity Reaction ◽  
Allergic Reaction ◽  
Delayed Type Hypersensitivity ◽  
Histological Features

Tattoos have become increasingly popular worldwide making adverse effects from tattoos a growing concern. In our report, we present a 51-year-old man who developed an unusual allergic reaction to the red ink portions of his tattoos that coincided with the initiation of ledipasvir/sofosbuvir treatment for his hepatitis C. Clinical and histological features were consistent with a delayed-type hypersensitivity reaction to red ink.

scholarly journals Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N2O in a 27-year old man: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Bär ◽  
Fabien Praz ◽  
Lorenz Räber
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Adverse Effects ◽  
Cardiovascular Effects ◽  
Drug Eluting Stent ◽  
Culprit Lesion ◽  
Vascular Events ◽  
The Public ◽  
Plaque Erosion ◽  
First Case

Abstract Background The recreational drugs cannabis and nitrous oxide (N2O) are known for pro-atherogenic effects and are associated with an elevated risk of myocardial infarction. These cardiovascular effects might be underestimated by the public. Culprit-lesion composition of myocardial infarctions associated with cannabis and N2O has been unknown so far. This case report aims to raise the awareness of the adverse cardiovascular effects of cannabis and N2O and reports, for the first time, optical coherence tomography (OCT) findings of the culprit lesion. Case presentation This is a case report of a 27-year old man with anterior ST-segment-elevation myocardial infarction (STEMI) after intoxication with cannabis and N2O. Coronary angiography and OCT revealed plaque erosion with subsequent subtotal thrombotic occlusion of the left anterior descending artery that was successfully treated with 1 drug-eluting stent. The patient was symptom free at 6 months follow-up and had been able to abstain from drug consumption. Conclusions This is the first case to demonstrate the association between cannabis and N2O abuse and plaque erosion on OCT in a young man with STEMI. In contrast to smoking, whose adverse effects are well-known, the cardiovascular effects of cannabis and N2O might be underestimated. These adverse effects should gain more awareness in the public to prevent early vascular events in young adults.

Incidence of hypersensitivity reactions in patients on H1-receptor antagonists receiving oxaliplatin-based chemotherapy

2021 ◽  
pp. 107815522110039
Author(s):  
Christine Barrett ◽  
Seon Jo Park ◽  
Lindsay Edmondson ◽  
Dulabh Monga
Keyword(s):  
Observational Study ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Controlled Trials ◽  
Severe Reaction ◽  
Hypersensitivity Reactions ◽  
H1 Receptor ◽  
Receptor Antagonists ◽  
Randomized Controlled ◽  
To Receive

Objective This study determined the incidence of hypersensitivity reactions in patients receiving oxaliplatin-based chemotherapy while on H1-receptor antagonists (H1RAs). Prophylaxis for patients receiving oxaliplatin is not currently recommended. H1RAs are used for the treatment of reactions; however, prophylactic H1RAs have not been well-studied. Methods This retrospective chart review included patients with solid tumor malignancies who received H1RAs while on oxaliplatin-based chemotherapy between August 1, 2016 and October 31, 2019. Results Of fifty-one patients, there were four hypersensitivity reactions (8%), most of which were mild, occurred within 60 minutes of the start of the infusion, and did not result in an interruption in treatment. One severe reaction occurred, which required discontinuation of therapy. Forty-two patients (82%) were able to receive at least 9 cycles of oxaliplatin without a reported reaction. Conclusion In this observational study, the incidence rate of hypersensitivity reactions in patients receiving oxaliplatin while on H1RAs was lower than reported in previous literature. Most reactions were mild, and patients were able to continue oxaliplatin-based therapy. With future, randomized controlled trials, H1RAs may prove to be effective in preventing or delaying the onset of hypersensitivity reactions related to oxaliplatin.

scholarly journals Management of myelofibrosis during pregnancy: A case report

2015 ◽  
Vol 72 (4) ◽  
pp. 383-385 ◽  
Author(s):  
Radmila Zivkovic ◽  
Olivera Markovic ◽  
Dragomir Marisavljevic ◽  
Tatjana Terzic ◽  
Ljiljana Tukic
Keyword(s):  
Case Report ◽  
Myeloproliferative Neoplasm ◽  
Primary Myelofibrosis ◽  
Normal Pregnancy ◽  
Hematologic Malignancies ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Pregnancy And Delivery ◽  
Normal Baby

Introduction. Primary myelofibrosis (PMF) is a clonal myeloproliferative neoplasm that occurs most commonly in the decade six of life and it is very rare in the young persons. Case report. We reported a 28-year-old female patient with primary myelofibrosis who had a normal pregnancy and delivery in the week 40 of pregnancy without any complications. Two years before the diagnosis of PMF she had normal pregnancy. The patient was treated with interferon-alpha and low dose aspirin during the whole pregnancy and with low-molecular-weight heparin a week before delivery and 6 weeks after. The patient had no complications during pregnancy. She delivered in term with healthy, normal baby weight. Conclusion. Decision about treatment strategy of pregnancy associated hematologic malignancies should be made for each patient individually.

scholarly journals A case report of anaphylaxis to chlorhexidine during urinary catheterisation

2012 ◽  
Vol 94 (4) ◽  
pp. e159-e160 ◽  
Author(s):  
J Noel ◽  
A Temple ◽  
GJA Laycock
Keyword(s):  
Case Report ◽  
Orthopaedic Surgery ◽  
Medical Literature ◽  
Chlorhexidine Gluconate ◽  
Hypersensitivity Reactions ◽  
Cell Surfaces ◽  
Urethral Catheterisation ◽  
Bacteriostatic Agent ◽  
Hand Antisepsis ◽  
Urinary Catheterisation

Chlorhexidine gluconate is a chemical antiseptic that is effective against Gram positive and negative bacteria and on certain viruses and fungi. A bacteriocidal and bacteriostatic agent, this cationic drug is absorbed on to negatively charged cell surfaces of organisms, disrupting the cell membrane, which results in increased permeability. Its use is mainly topical as a surgical hand antisepsis, site preparation/cleansing and for pre-genitourinary procedures such as urethral catheterisation. Like any drug, caution should be employed with its use as hypersensitivity reactions are being documented increasingly in the medical literature. In the following case, we present a patient who was catheterised with the chlorhexidine containing Instillagel® (CliniMed, High Wycombe, UK), prior to undergoing elective orthopaedic surgery.

scholarly journals Successful treatment of gastrointestinal mucormycosis in an adult with acute leukemia: case report and literature review

2017 ◽  
Vol 24 (1) ◽  
pp. 61 ◽  
Author(s):  
A. Alghamdi ◽  
A. Lutynski ◽  
M. Minden ◽  
C. Rotstein
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Acute Leukemia ◽  
Fungal Infection ◽  
Antifungal Therapy ◽  
Successful Treatment ◽  
Invasive Fungal Infection ◽  
Hematologic Malignancies ◽  
Considerable Morbidity ◽  
Delays In Diagnosis

Mucormycosis has emerged as an important cause of invasive fungal infection in patients with hematologic malignancies. Gastrointestinal mucormycosis is an unusual presentation of this invasive fungal infection, and it causes considerable morbidity and mortality. Such outcomes are due in part to a nonspecific presentation that results in delays in diagnosis and treatment. Successful treatment of gastrointestinal mucormycosis involves surgical debridement and appropriate antifungal therapy.

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