Abstract
BackgroundRecombinant human erythropoietin, such as epoetin alfa and darbepoetin alfa, is an important therapy for anemia due to chronic renal failure. Allergy to recombinant human erythropoietin and the need for desensitization are rare.Case presentationWe report here a novel epoetin alfa outpatient desensitization protocol in a girl who developed delayed cutaneous hypersensitivity to subcutaneous epoetin alfa and intravenous darbepoetin alfa. An initial attempt at traditional epoetin alfa desensitization failed, so we created a slower 17-day outpatient desensitization that succeeded and allowed treatment continuation.ConclusionsThis case highlights the notion that delayed-type hypersensitivity to recombinant human erythropoietin can occur as evident by reproducible reactions after repeated exposures and slow outpatient desensitization can be considered when a trial of more rapid induction of tolerance is unsuccessful.
Highlights
Recombinant human erythropoietin, such as epoetin alfa and darbepoetin alfa, is an important therapy for anemia due to chronic renal failure
Recombinant human erythropoietin is a mainstay treatment for anemia associated with chronic renal failure
We present a case of a patient who failed a previously published 2-day epoetin alfa desensitization regimen but tolerated epoetin alfa after desensitization over 17 days
Summary
Two key points make this case noteworthy. First, we proved an antigen-specific allergy by provoking the same reaction upon re-administration, which is infrequently done in case reports of successful desensitization. Often the severity of reaction makes physicians reluctant to rechallenge In this case, her reactions from the initial desensitization attempt and subsequent exposure to an intravenous bolus after missing a few subcutaneous doses provided good evidence of a true allergy. The slow desensitization was successful in a patient who had failed rapid desensitization. This bolsters the concept that desensitization protocols must be tailored to the patient’s reaction and any single protocol may not be universally applicable. Author details 1 Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305, USA. 3 Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
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