Evaluation and management of pediatric patients with anaphylactoid reactions to deferoxamine mesylate [4]

Raz Somech*, Kimberley Seaban-Adel, Adelle Atkinson, Melanie Kirby-Allen

*Corresponding author for this work

Research output: Contribution to journalLetterpeer-review

Abstract

Indications:3 patients with transfusional iron overload. Coexisting diseases: thalassemia major (n=2) and sickle cell disease (n=1).

Patients:3 patients, age range 6-14 years.

TypeofStudy:Evaluation and management of anaphylactoid reactions to Desferal in three thalassemic children with transfusional iron overload or sickle cell disease is described. 3 case reports.

DosageDuration:During desensitization protocol: initially 0.00375 mg in 10 mL of saline solution followed by 0.0375, 0.375, 3.75, and 37.5 mg in 10 mL of saline solution at 15-minute intervals and then 375 and 500 mg in 15 mL of saline solution at 70-minute intervals as iv infusion; 35 mg/kg daily for 5 days weekly if no adverse events occurred; then 50 mg/kg daily for 5 days weekly as maintenance dose. Duration not stated.

Results:After exposure to Desferal, patients developed anaphylactic-like symptoms, including breathing difficulties, wheezing, diffuse urticaria, and generalized itching in patient 1; diffuse hives in patient 2; and hypotension and severe abdominal pain in patient 3. Skin test showed positive results in patients 2 and 4, including a pseudopod, which was evident in the 1/100 dilution in patient 3. Patients 1 and 2 underwent an advanced rapid desensitization protocol using a 7-step challenge of increasing Desferal doses. No adverse symptoms occurred the day after desensitization, and later Desferal was used safely and effectively.

FreeText:Tests: prick (1/10 dilution) and intradermal (1/100, 1/1,000, 1/10,000, and 1/100,000 dilutions) skin tests for evaluation of anaphylaxis.

AdverseEffects:3 patients had anaphylactic-like symptoms including breathing difficulties, wheezing, diffuse urticaria, generalized itching (patient 1), diffuse hives (patient 2), and hypotension and severe abdominal pain (patient 3).

AuthorsConclusions:In conclusion, these cases highlight the utility of low concentrations of deferoxamine mesylate for skin testing in the evaluation of patients with suspected anaphylactic reactions to deferoxamine mesylate. When an alternative therapy is not available for patients with intolerance to deferoxamine mesylate, a rapid intravenous desensitization procedure is safe and efficacious.

Original languageEnglish
Pages (from-to)575-576
Number of pages2
JournalAnnals of Allergy, Asthma and Immunology
Volume99
Issue number6
DOIs
StatePublished - Dec 2007
Externally publishedYes

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