Oral Desensitization Protocol Research Articles

Hypersensitivity reaction to Abiraterone, successful desensitization protocol in prostate cancer patient.

In prostate cancer, androgens are key in the growth of both normal prostate and cancer cells. Abiraterone acetate inhibits CYP17, an important target in prostate cancer given its central role in the production of adrenal and tumor-derived androgens. Although abiraterone is generally well tolerated, common adverse effects such as hypertension, hypokalemia, and hepatotoxicity have been reported. We present the case of an 83-year-old Mexican man with high-volume EC IV prostate cancer resistant to castration, orchiectomy, and bone, liver, and lung metastases. First-line treatment with the CHAARTED scheme was indicated, by patient decision refuse chemotherapy treatment. On the fourth day of starting treatment, he developed pruritic erythematous macular skin lesions and urticaria on the posterior chest that resolved spontaneously. A generalized erythematous and pruritic maculopapular rash appeared 12 days after starting abiraterone, for which she was referred to allergies. An oral provocation test was performed for two days, presenting localized macular lesions eight hours after the administration of abiraterone. An oral desensitization protocol was carried out for ten days in which no hypersensitivity reactions were observed, thus achieving the successful administration of abiraterone.

GASTROINTESTINAL SYMPTOMS WITH ASPIRIN-EXACERBATED RESPIRATORY DISEASE MAY INCREASE RISK FOR FAILURE DURING RAPID ASPIRIN DESENSITIZATION

<h3>Introduction</h3> Aspirin-exacerbated respiratory disease (AERD) is a chronic condition with polyposis, asthma, and sensitivity to nonsteroidal anti-inflammatory drugs. Management of AERD is often through aspirin desensitization, which historically was a two-day or longer process. Few studies have examined specific phenotypes with the safety and efficacy of a one-day oral aspirin desensitization protocol. <h3>Methods</h3> We completed a single-center, retrospective chart review analyzing all patients with AERD who underwent a rapid, one-day aspirin desensitization from October 2018-April 2022. Descriptive statistics were used to analyze the data. <h3>Results</h3> Thirty-two of 36 (89%) subjects underwent successful aspirin desensitization. Sixty-six percent (21/32) of successful desensitization were completed in a single day (6.4 hours) and 34% (11/32) in two days (9.4 hours). The most common dose to illicit symptoms was 81 mg in the one-day group and 120 mg in the two-day group. Sinonasal symptoms during the reaction were the most common in both groups. Thirty-eight percent (8/21) of the one-day subjects discontinued aspirin maintenance therapy with 50% (4/8) initiating dupilumab. Similarly, 27% (3/11) of the two-day group discontinued aspirin with 33% (1/3) initiating dupilumab. Of the 4 subjects who failed desensitization, 3 had severe gastrointestinal symptoms with 1 requiring epinephrine at the clinic. <h3>Conclusion</h3> A single-day oral aspirin desensitization procedure appears safe and effective for AERD. Patients who failed desensitization more likely had gastrointestinal reactions to aspirin. Further research is necessary to explore the role of gastrointestinal reactions in AERD and the likelihood of failing aspirin desensitization.

A SUCCESSFUL 4-HOUR ACETYLSALICYLIC ACID DESENSITIZATION PROTOCOL IN AN ATOPIC PATIENT WITH ACUTE CORONARY SYNDROME

<h3>Introduction</h3> Acetylsalicylic acid (ASA) is the world's most widely used drug, essential for treating patients with cardiovascular diseases, in particular acute coronary syndrome (ACS) and chronic ischemic heart disease. ASA and other non-steroidal anti-inflammatory drugs (NSAIDs), especially those that inhibit cyclo-oxygenase-1, can cause hypersensitivity reactions. A history of ASA hypersensitivity typically leads to the avoidance of this potentially lifesaving therapy in patients with coronary artery disease (CAD). ASA desensitization is crucial in patients with ACS and a history of ASA hypersensitivity reactions. <h3>Case Description</h3> A 58-year-old male with a long history of hypertension and unspecified arrythmia was admitted due to acute chest pain. He referred previous hypersensitivity reactions to NSAIDs (ASA, acetaminophen, ibuprofen and metamizole) from hives to angioedema, as well as previous history of allergic rhinitis, fruit-latex syndrome, eosinophilic esophagitis, chronic spontaneous urticaria and angioedema. Initial work-up confirmed the diagnosis of acute myocardial infarction without ST elevation and the patient underwent early coronary angiography with drug-eluting stent placement. Due to previous reactions to ASA and the indication of dual anti-platelet therapy, bedside desensitization was performed including pretreatment with montelukast and cetirizine. The patient successfully completed the oral ASA desensitization protocol in 8 steps, reaching a cumulative dose of 308 mg (Figure 1). Nine months after the procedure the patient continued with 100 mg of ASA daily without adverse reactions. <h3>Discussion</h3> ASA rapid desensitization protocols have proven to be safe and effective in patients with CAD, including ACS, independent of the type of ASA hypersensitivity, reducing associated morbimortality.

SAT-504 Delayed Hypersensitivity to Levothyroxine, and Oral Desensitization

Introduction- Hypothyroidism is a common endocrine disorder, affecting about 4.6 percent of the U.S. population aged 12 and older. The most common treatment is synthetic thyroxine hormone supplementation-levothyroxine, starting at 1.6 mcg/kg.Hypersensitivity reactions to levothyroxine are rare. Two cases have been published of successful oral desensitization, for suspected IgE mediated reactions. There are no published protocols describing induction of drug tolerance to immunologic, non-IgE mediated reaction to levothyroxine. The objective of this case report is to describe a novel outpatient protocol, for oral desensitization to levothyroxine, in the setting of a delayed immunologic (non-IgE mediated) reaction.Case report- A 66 year old male with history of hypothyroidism, diagnosed in 2010 presented to outpatient endocrinology. Between 2010 and 2019, the patient was on multiple brands and formulations of levothyroxine. He noticed an itchy, raised rash on abdomen, chest and arms, within a few months after starting each of the above. No mucosal involvement or signs of end organ damage were noted. The rash was deemed a type IV delayed hypersensitivity reaction, based on history and histological findings on biopsy. The patient reported clearance of the rash when he was off any form of thyroid supplementation, and reappearance of the rash when he re-trialed it. The patient had normal thyroid stimulating hormone (TSH) levels while he was on supplementation despite the rash. The patient’s TSH after discontinuing treatment was 104 (uIU/mL) and free thyroxine (T4) was 0.13 ng/dl (0.9–1.7). All components of previous brands of levothyroxine were compared and no common ingredient was thought to be contributing to hypersensitivity reactions. Subsequently, an oral desensitization protocol was initiated at 0.075 mcg daily with weekly increase in doses over seven weeks to reach a target dose of 75 mcg.Discussion- The patient was tried on different brands of levothyroxine and dessicated thyroid hormone. He consistently developed a type IV hypersensitivity reaction within a few months after starting them. The patient had uncontrolled TSH levels after discontinuing the treatment and was at risk of complications of untreated hypothyroidism. This necessitated the need for desensitization. There have been previous case reports of oral or IV desensitization, in suspected IgE mediated reactions, but we describe the first case of induction of levothyroxine tolerance in an immunologic non-IgE mediated reaction. Subsequently, the patient tolerated a therapeutic dose of levothyroxine, with no appearance of rash or itching, for almost 6 months. This case report describes a novel approach to levothyroxine desensitization over a period of seven weeks in an outpatient setting in response to a delayed type hypersensitivity reaction.

A rapid desensitization protocol in a case of drotaverine-induced serum sickness-like reaction in a pregnant woman: A case report.

Drotaverine is an antispasmodic drug used to treat gastrointestinal and genitourinary smooth muscle spasms. There are very few hypersensitivity reactions reported. Serum sickness-like disease is an immune-complex-mediated hypersensitivity reaction that presents with some typical features that include rash, fever and articular impairment sometimes associated with liver and renal dysfunctions, beginning 1-2 weeks after exposure to a culprit drug. Diagnosis is a clinical one, made usually on the basis of knowledge obtained by medical history and physical examination. Desensitization usually is recommended for type I reaction, but may be a solution for this type of immunological reaction when other therapeutic alternatives are ineffective or do not exist. We report the case of a 29-year-old pregnant female who developed serum sickness-like reaction after 5 days of daily drotaverine oral administration. The patient required antispasmodic treatment, with this drug, having a pregnancy with an imminent risk of abortion and the other therapeutic alternatives being ineffective. She underwent a rapid 7-step oral drotaverine desensitization protocol without recurrence of serum sickness-like reaction. To our knowledge, this is the first case report of desensitization to drotaverine, previously involved in a serum sickness-like reaction.

Oral desensitization to entecavir: An 11-step protocol

Introduction Chronic hepatitis B infection (CH-B) has a high risk of progression to cirrhosis and hepatocellular carcinoma. Entecavir, a guanosine nucleoside analogue, is often the drug of choice in nucleoside-naive patients with CH-B because of its low rate of viral resistance. Case Description 61-year old Caucasian female with a history of cirrhosis secondary to CH-B who presented to the Allergy clinic with a self-reported allergy to Entecavir. She described a history of unilateral throat swelling, left ankle swelling and worsening of her peripheral neuropathy within 7 days of initiating therapy. Her symptoms presented two hours after oral ingestion of her daily antiviral medication. The acute reaction lasted for six hours and completely resolved three days after discontinuation of the medication. The patient was unable to tolerate one of the alternative medications (tenofovir disoproxil fumarate) due to side effects and the other was cost-prohibited (peg INF-alpha). The patient deferred skin or provocation testing. The patient underwent desensitization protocol (Figure 1) without adverse reactions. Furthermore, she reported no side effects with daily entecavir at her 6-month follow-up. The patient had favorable outcomes evident by normal liver enzymes and hepatitis B e antigen seroconversion at 6 months. Discussion To the best of our knowledge, an oral desensitization protocol for Entecavir has not been reported in the literature. We present a successful desensitization to Entecavir in a patient with a previous hypersensitivity reaction.

A One-day, 90-minute Aspirin Challenge and Desensitization Protocol in Aspirin-Exacerbated Respiratory Disease

Aspirin challenge and desensitization remains the gold standard in diagnosis and treatment of patients with aspirin-exacerbated respiratory disease (AERD), but the protocols can be time and resource intensive. The objective of this study is to provide evidence that oral aspirin challenge and desensitization can be safely performed in an outpatient setting in one day. Forty-four patients with confirmed diagnosis of AERD, stable asthma and baseline FEV1 ≥70% of predicted completed an oral aspirin challenge and desensitization protocol. The starting dose was 40.5mg with escalating doses of aspirin (81, 162.5, 325mg) at 90-minute intervals until symptoms were provoked. Desensitization was defined as tolerating a repeated administration of the provocative dose and at least one subsequent aspirin dose, bringing total aspirin ingested during the in-clinic desensitization to ≥325mg. Ninety-three percent of patients completed the challenge and desensitization in one day, with an average protocol completion time of 9 hours and 29 minutes. Two patients (4.6%) chose to complete the protocol over two days. One patient (2.3%) was discontinued from the protocol due to on-going abdominal discomfort and diarrhea. No patient required epinephrine, emergency department visit or hospitalization. Patients with AERD on a stable asthma regimen and with a baseline FEV1≥70% can be safely desensitized to aspirin using a 90-minute dose escalation protocol, starting at a dose of 40.5mg, and defining desensitization as tolerance of the repeated provocation dose and at least one subsequent aspirin dose, bringing total cumulative daily dose to ≥325mg. This protocol can routinely be completed in one day.

Wheat allergy – clinical implications and management

Grain allergies are common food allergies, that are typically but not only seen in individuals with other associated food allergies. The immunologic responses to grain proteins can be IgE and/or non-IgE mediated. Wheat allergy is the most common of the cereal grain allergies. It usually begins in early childhood and is outgrown by adolescence, although some retain it beyond the teenage years. Immunoglobulin E (IgE)-mediated wheat allergy is reported to affect 0.2 to 1.3 percent of children in Europe and 0.4 percent of children in the United States. The onset of wheat allergy in adulthood is typically not seen, unless it is related to an occupational exposure. Epidemiologic data for the other grains is largely missing. Immunoglobulin E (IgE)-mediated food-triggered reactions generally occur immediately, within minutes to two hours after ingestion. These reactions can present with skin, oropharyngeal, upper and lower respiratory tract, gastrointestinal tract, and/or cardiovascular signs and symptoms. The reactions can vary from mild cutaneous reactions to life-threatening anaphylaxis. Positive diagnose is based on determining the plasmatic level of specific IgE and performing skin prick test for wheat, methods that have poor specificity and sensitivity in predicting oral food challenge test outcomes. The gold standard test remains oral food challenge (OFC) test for wheat. Most of the studies have proven its utility, even in children with high levels of wheat specific IgE. The diagnose of non-IgE mediated reactions is based on clinical presentation and plasmatic levels of specific antibodies, other than IgE. The management of grain allergy does not differ from that of other food allergies. It requires instructions on avoidance and treatment of reactions in the event of accidental exposure. It includes education about grain alternatives. It also includes monitoring for nutritional issues and for the resolution of the allergy. Preliminary data on specific oral tolerance induction to wheat through oral desensitization protocols have shown some promise in children, but it is still considered an experimental therapy.

A 1-Day, 90-Minute Aspirin Challenge and Desensitization Protocol in Aspirin-Exacerbated Respiratory Disease

Aspirin challenge and desensitization remains the criterion standard in diagnosis and treatment for patients with aspirin-exacerbated respiratory disease (AERD), but the protocols can be time and resource intensive. To provide evidence that oral aspirin challenge and desensitization can be safely performed in an outpatient setting in 1 day. Forty-four patients with a confirmed diagnosis of AERD, stable asthma, and baseline FEV1 value greater than or equal to 70% of predicted completed an oral aspirin challenge and desensitization protocol. The starting dose was 40.5 mg with escalating doses of aspirin (81, 162.5, 325 mg) at 90-minute intervals until symptoms were provoked. Desensitization was defined as tolerating a repeated administration of the provocative aspirin dose and at least 1 subsequent dose, bringing the total aspirin ingested during the in-clinic desensitization to 325 mg or more. Ninety-three percent of patients completed the challenge and desensitization in 1 day, with an average protocol completion time of 9 hours and 29 minutes. Two patients (4.6%) chose to complete the protocol over 2 days. One patient (2.3%) was discontinued from the protocol because of ongoing abdominal discomfort and diarrhea. No patient required epinephrine, emergency department visit, or hospitalization. Patients with AERD on a stable asthma regimen and with a baseline FEV1 value greater than or equal to 70% can be safely desensitized to aspirin using a 90-minute dose escalation protocol, starting at a dose of 40.5 mg, and defining desensitization as tolerance of the repeated provocation dose and at least 1 subsequent aspirin dose, bringing total cumulative daily dose to 325 mg or more. This protocol can routinely be completed in 1 day.

SUCCESSFUL RAPID ORAL DESENSITIZATION TO SULFASALAZINE: A NOVEL 11 STEP PROTOCOL

Introduction Sulfasalazine (SSZ) is usually associated with non-immediate hypersensitivity reactions. Immediate hypersensitivity reactions from sulfasalazine have not been well described. Case Description A 58-year-old female was evaluated for SSZ hypersensitivity reaction. She had a history of inflammatory arthritis with persistent arthralgia despite oral prednisone and methotrexate. The patient had a history of recurrent infections in the setting of hypogammaglobulinemia thus treatment with biologic agents was deferred given concern for worsening hypogammaglobulinemia. SSZ was prescribed 5 years prior for inflammatory arthritis, however, the patient developed bilateral ear pruritus and cough with wheezing within 30 minutes of receiving the drug. The patient deferred skin testing to sulfasalazine. The patient underwent an open oral challenge with 125 mg of SSZ and developed bilateral ear pruritus and coughing within 20 minutes of administration; vital signs were stable without evidence of hypotension. She received antihistamines with resolution of symptoms 40 minutes thereafter. Given that no alternative disease-modifying anti-rheumatic drug was identified, the patient underwent a successful novel 11-step oral desensitization to sulfasalazine 500 mg following pre-medications (Table 1). The patient only developed mild throat pruritus during step 6 without further reactions. The patient has tolerated SSZ without further reactions till date. Discussion Immediate reactions to SSZ are rare and most previous limited number of published desensitization protocols were intended for non-immediate hypersensitivity reactions. We present a successful oral desensitization protocol to SSZ in a patient with a previous immediate hypersensitivity reaction to SSZ which was confirmed by an open oral challenge.

Invariant natural killer cells change after an oral allergy desensitization protocol for cow's milk.

Cow milk (CM) allergy (CMA) affects up to 3% of the paediatric population and recent data suggest that only about 50% will outgrow by age 8. Oral immunotherapy (OIT) is a type of immune-modulating treatment that is able to induce desensitization to food allergens, to increase tolerance threshold, to reduce the risk of anaphylaxis, and to improve the patient's quality of life. The examination of the immunological changes observed during the establishment of food allergy (FA) desensitization in FA patients is a window into the pathogenesis of food allergy and food tolerance development. In this pathway, we have previously found that invariant natural killer T cells (iNKTs) are involved in CM allergy sensitization and now examine their role in OIT. In this study, 10 of the 11 children with CM induced anaphylaxis enrolled in a CMA OIT clinical trial and completed the protocol. Peripheral blood iNKTs were quantitatively and qualitatively via flow cytometry characterized ex vivo and after culture with milk lipids before and after completing the OIT protocol. After completing OIT for CM, children were able to reintroduce CM in their diet. For the first time, we demonstrated that OIT induced a significant increase in the peripheral blood iNKT, as well as their switch from a T helper (Th-2; ie IL-4, IL-13) to Th-1 (ie IFN-γ) cytokine profile. This study confirms the efficacy and safety of CM-OIT as well as the role of iNKT cells in CM allergy.

A Novel Two Day Desensitization Protocol to Oral Mesalamine

Ulcerative proctosigmoiditis is a chronic inflammatory condition that is initially treated with mesalamine, a preferred treatment to steroids and immunomodulators. Hypersensitivity reactions to mesalamine have been reported and a limited number of desensitization protocols have been published taking between 3 days to weeks. We present a case of a patient with ulcerative proctosigmoiditis and aspirin allergy with adverse reactions to mesalamine who failed an oral mesalamine challenge. She subsequently underwent successful mesalamine desensitization with a rapid 2 day protocol. The desensitization took place in the intensive care unit. The starting dose of mesalamine was 1mg. On day 1, incremental doses were given every 30 minutes up to 500mg. On day 2, the patient received a total of 2.5 grams of mesalamine, which was her targeted daily dose. The patient was successfully desensitized after 2 days with one hypersensitivity reaction. She developed mild shortness of breath with a drop in FEV1 from 450 to 350 on day 1 of the desensitization, which resolved with nebulized albuterol and fexofenadine. Since discharge from the hospital, she continued mesalamine 2.4 grams daily without adverse reactions. This case demonstrates a patient with mesalamine hypersensitivity can be safely offered a rapid 2 day oral desensitization protocol, and maintained on the medication for long term management of ulcerative proctosigmoiditis.

Successful Metronidazole Desensitization Using Modified Oral Protocol

Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the United States and affects over 11% of women over the age of 40 [1]. Metronidazole and tinidazole are the only medications that are recommended by the Centers for Disease Control for the treatment of trichomoniasis1. Alternative therapies are not standardized and limited in efficacy [2]. Case reports suggest that there is cross-reactivity between metronidazole and tinidazole [3]. The body of literature describing metronidazole hypersensitivity is scarce and to date, the incidence is unknown. Skin-prick testing to metronidazole is not validated. Three metronidazole desensitization protocols have been described, including one intravenous3 and two oral protocols [4,5]. In 2008, the Centers for Disease Control and Prevention published a study documenting a total of 127 patients with suspected metronidazole hypersensitivity, among whom 15 patients underwent metronidazole desensitization2. Among those 15 patients, 7 patients underwent a 14-dose intravenous protocol3 and 8 patients underwent an 8-dose oral protocol5. All 15 patients achieved infection cure. More recently, a 12dose modified oral desensitization protocol was described by Gendelman and colleagues in 2014.

Acetylsalicylic acid desensitization in patients with coronary artery disease: A comprehensive overview of currently available protocols

BackgroundAcetylsalicylic acid (ASA) represents the basis of pharmacological therapy for cardiovascular prevention. However, several patients are excluded from the benefits of ASA for hypersensitivity problems, and controversies still exist on their management. The aim of present study was to evaluate the safety and efficacy of ASA desensitization protocols in patients requiring dual antiplatelet therapy for coronary artery disease. MethodsLiterature archives and main scientific sessions' abstracts were scanned for studies describing desensitization protocols for patients with ASA hypersensitivity. Primary endpoint was the tolerance of ASA maintenance therapy (protocol success). Secondary endpoints were: 1) the occurrence of hypersensitivity symptoms during the protocol, 2) the rate of ASA discontinuation at follow-up; 3) recurrent cardiovascular ischemic events. ResultsWe finally selected 14 studies out of 335 initially screened citation, reporting complete data on protocol desensitization strategies, with a total of 256 patients. Among them 213 (83.2%) underwent an oral desensitization protocol, while 43 received endovenous ASA. The protocol was successfully completed in 238 out of 256 patients (92.9%), who were subsequently kept on chronic daily therapy with ASA. The weighted success proportion was wP [95%CI]=93[89.8–96.1]%. Hypersensivity symptoms occurred during the desensitization protocol in 29 patients, with a pooled events rate of 11.3[7.5–15.2]%. All adverse reactions were safely faced with pharmacological interventions. In 11 of these patients, slowing the protocol or restarting another ASA challenge could successfully achieve the tolerance. The rate of ASA discontinuation and major cardiovascular events was extremely low (6.1 and 2.3% respectively). ConclusionsAspirin desensitization protocols represent a safe and effective option for the management of patients with a cardiovascular indication to ASA and history of allergy to ASA. Future randomized trials are certainly needed to confirm present findings and provide indications for the optimization of these protocols.

Successful Desensitization of Two Patients with ALK-Positive Lung Cancer and Hypersensitivity to Crizotinib

The tyrosine kinase inhibitor crizotinib is an effective therapy for patients with cancers harboring rearrangements of the anaplastic lymphoma kinase (ALK) gene. Here, we describe two patients with advanced ALK-positive lung cancer who developed hypersensitivity to crizotinib, requiring temporary discontinuation of the drug. Both patients were treated with a rapid oral desensitization protocol allowing them to resume crizotinib without further signs or symptoms of hypersensitivity.

Late latent syphilis in a patient with end-stage renal disease and presumptive penicillin allergy

Pharmacotherapy challenges in a case of late latent syphilis complicated by end-stage renal disease and presumptive penicillin allergy are described. A 58-year-old white woman was admitted to the hospital for symptoms including altered mental status, shortness of breath, and chest pain. The initial workup isolated syphilis immunoglobulin G antibody. A treponemal test was reactive, and a nontreponemal test was nonreactive; analysis of cerebrospinal fluid did not indicate neurosyphilis. The patient was diagnosed as having late latent syphilis of unknown duration, for which the standard treatment is intramuscular penicillin G benzathine 2.4 million units once weekly for three weeks. Given the patient's advanced renal disease and other serious comorbidities, there were concerns about the potential need for renal dosage adjustment and repeated desensitization. However, given the slow absorption and long half-life of penicillin G and published data indicating its safe use in the context of hemodialysis, the treating clinicians decided to proceed with penicillin G therapy at the usual dose after an oral penicillin desensitization protocol; repeat desensitization before two subsequent injections was not performed. The patient completed the full course of penicillin G without incident. Notably, skin testing was not performed to definitively establish penicillin allergy. Microbiological testing to determine a cure of syphilis was not performed. After the completion of an oral desensitization protocol, the standard three-dose regimen of intramuscular penicillin G for late latent syphilis was safely administered to a hemodialysis patient without dosage adjustment or repeated desensitization.

Modified Oral Metronidazole Desensitization Protocol

The Center for Disease Control guidelines recommend desensitization to metronidazole in patients with trichomoniasis and hypersensitivity to metronidazole. There is only one published oral metronidazole desensitization protocol. The purpose of this study was to design a new, more gradual oral desensitization protocol to decrease systemic reactions that may occur when using the previously published protocol. We present two patients with presumed IgE-mediated allergy to metronidazole who underwent oral desensitization using our modified protocol. Case 1 was a 65-year-old woman with trichomoniasis who presented for metronidazole desensitization with a history of intraoperative anaphylaxis and positive skin tests to metronidazole. The patient tolerated six doses of the modified desensitization but developed systemic symptoms of nasal congestion and diffuse pruritus after the 25- and 100-mg doses. Both reactions were treated with intravenous (i.v.) antihistamines. Because of gastrointestinal irritation, the desensitization was completed at a dose of 250 mg orally every 6 hours. Case 2 was a 42-year-old woman with trichomoniasis and a history of hives immediately after administration of i.v. metronidazole who presented for desensitization. The patient had negative skin-prick and intradermal testing to metronidazole. She developed lip tingling and pruritus on her arms 15 minutes after the 10-mg dose. Fexofenadine at 180 mg was given orally and symptoms resolved. She tolerated the rest of the protocol without reaction and received a total dose of 2 g of metronidazole. Our oral metronidazole desensitization for presumed IgE-mediated reactions offers a second option for physicians wishing to use a more gradual escalation in dose.

Efficacy and safety of oral desensitization in children with cow's milk allergy according to their serum specific IgE level

BackgroundOral desensitization in children allergic to cow's milk proteins is not risk free. The analysis of factors that may influence the outcome is of utmost importance. ObjectiveTo analyze the efficacy and safety of the oral desensitization according to specific IgE (sIgE) level and adverse events during the maintenance phase. MethodsThirty-six patients allergic to cow's milk (mean age, 7 years) were included in an oral desensitization protocol. Patients were grouped according to sIgE levels (ImmunoCAP) into groups 1 (sIgE <3.5 kU/L), 2 (3.5-17 kU/L), and 3 (>17-50 kU/L). Nineteen children were included as a control group. Serum sIgE levels to cow's milk and its proteins were determined at inclusion and 6 and 12 months after finishing the desensitization protocol. ResultsThirty-three of 36 patients were successfully desensitized (200 mL): 100% of group 1 and 88% of groups 2 and 3. Desensitization was achieved in a median of 3 months (range, 1-12 months); 90% of the patients in group 1, 50% of the patients in group 2, and 30% of the patients in group 3 achieved tolerance in less than 3 months (P = .04). In the control group only 1 child tolerated milk in oral food challenge after 1 year. During the induction phase, there were 53 adverse events in 27 patients (75%). Patients of groups 2 and 3 had more severe adverse events compared with group 1. During the maintenance phase, 20 of 33 patients (60%) had an adverse event. ConclusionOral desensitization is efficacious. Tolerance is achieved earlier when sIgE is lower. Severe adverse events are frequent, especially in patients with higher sIgE levels. Trial Registrationclinicaltrials.gov Identifier: NCT01641731

Oral Rush Desensitization to Egg: Efficacy and Safety

Rodriguez R Garcia, JM Urra, F Feo-Brito. Clin Exp Allergy. 2011;41(9):1289–1296 Previously published oral desensitization protocols require weeks to months. The current study evaluates the safety, efficacy, and immunologic effects of a rapid egg oral desensitization protocol. Twenty-three patients between 5 and 17 years of age with symptomatic immunoglobulin (Ig) E-mediated egg allergy were recruited from the Allergy Clinic of Ciudad Real General Hospital. Patients had a clinical history of IgE-mediated egg allergy and at least 1 of the following: a positive skin prick test to commercial egg extract, detection of serum specific IgE (>0.35 kU/L) to egg white or its proteins measured by fluorescence …

Oral Desensitization as a Useful Treatment in 2-Year-old Children With Cow’s Milk Allergy

A Martorell, B De la Hoz, MD Ibanez. Clin Exp Allergy. 2011;41(9):1297–1304 To assess the safety and efficacy of an oral desensitization protocol in 2-year-old children with allergy to cow’s milk protein (CMP) as a therapeutic alternative to elimination diet. Sixty patients aged 24 to 36 months with immunoglobulin (Ig) E-mediated allergy to CMP enrolled in this multicenter study. Inclusion criteria included immediate-type clinical manifestations within 2 hours of cow’s milk ingestion, skin prick tests ≥3 mm, and serum specific IgE levels ≥0.35 kU/L for whole cow’s milk, casein, α-lactalbumin, or β-lactoglobulin. Persistence of CMP …