MON-063 Rare Cases of Local and Systemic Allergic Reactions Associated with Recombinant Human Growth Hormone Treatment Including Fixed Drug Eruption and Anaphylaxis

Abstract

Recombinant human growth hormone (rhGH) is widely used to increase growth velocity not only in growth hormone deficiency, but also in other growth related disorder to increase final adult height. RhGH is a safe and effective treatment, which has few side effects. Possible side effects include allergic reaction, joint pain, headache, progression of spine curvature in scoliosis, temporary increase in blood sugar levels. GH-associated allergic reactions include mostly local erythema and swelling at the injection site, and there have been a few reports about those reactions. However, we experienced fixed drug eruption associated with rhGH, which was thought to be an unusual local side effect. Also, we experienced another rare case showing GH-associated systemic allergic reactions including anaphylaxis, which have not been described. So, we would like to introduce these cases who developed repetitive allergic reactions to two different kinds of preservative-containing rhGH, fixed drug eruption and anaphylaxis. Case 1. At the time of initial visit, the patient was at the age of 9 years and 3 months with Tanner stage 3 development. Her height and weight was measured as 128cm (13%) and 27.6kg (24%). Bone age was advanced as 10.9 years by the TW3 method. She was diagnosed as precocious puberty, and combined treatment with GnRH analog and rhGH was started to delay rapid pubertal growth and improve her final adult height because of her short stature for advanced bone age. However, after 2 months of treatment, she showed oval shape of erythematous patch and urticaria on left cheek, which reappeared at the same site after switching to another kind of preservative-containing rhGH. The symptom was diagnosed as fixed drug eruption associated with rhGH therapy, and after discontinuing rhGH, the symptom resolved. Case 2. A 13 years and 8 months girl visited our clinic to check her growth status. She was 154.6cm (29%) tall and 40.1kg (9%), and showed Tanner stage IV development. Her MPH was calculated as 161.5cm, and pelvic AP x-ray showed Risser stage 3–4, which is compatible to 14.5–15 years of bone age in girls. Medical intervention for more height gain was thought to be ineffective, however, the patient and her parents strongly requested rhGH treatment. So, we decided to try rhGH treatment for only three months. However, after 1 weeks of treatment, she complaint of repetitive urticaria and itching sensation, which subsided after taking anti-histamine drugs. After switching to another kind of rhGH, she still complaint of generalized urticaria and itching sensation, aggravated with dyspnea and facing swelling especially around her eyes, the symptoms of anaphylaxis and angioedema. Because of those systemic allergic reactions from rhGH, we quit the treatment. In conclusion, physicians should be aware of these potential side effects and prepare appropriate management and evaluation of patients receiving rhGH treatment.