RESUMO
Iron deficiency is the main cause of anemia in both sexes, with women being more commonly affected. Iron therapy is currently considered an effective and safe remedy to replenish the iron storages. Iron can be administrated both orally and intravenously. In particular, intravenous (IV) iron therapy is widely used when oral iron preparations are either not tolerated or ineffective. Indeed, IV iron improves iron stores more rapidly. Two main immunological responses have been described for iron hypersensitivity reactions (HSRs): IgE-mediated allergy and complement activation-related pseudo-allergy. Here, we report 3 cases of adult patients with iron allergy, who were successfully treated with two different desensitization procedures, respectively. Analysis of these cases demonstrates that, in the presence of HSRs to iron products, desensitization is an effective and safe procedure that prevents treatment discontinuation and hence allows therapeutic target achievement.
Assuntos
Anemia Ferropriva/diagnóstico , Hipersensibilidade/diagnóstico , Ferro/efeitos adversos , Adulto , Anemia Ferropriva/tratamento farmacológico , Clorfeniramina/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Compostos Férricos/uso terapêutico , Hematínicos/uso terapêutico , Humanos , Hipersensibilidade/etiologia , Ferro/uso terapêutico , Maltose/análogos & derivados , Maltose/uso terapêutico , Pessoa de Meia-Idade , Testes CutâneosRESUMO
BACKGROUND: Brentuximab vedotin (BV) is an antibody-drug conjugate formed by an anti-CD30 chimeric IgG1 conjugated with monomethyl-auristatin-E. BV targets the CD30+ cells, which characterize Hodgkin lymphoma as well as anaplastic large cell lymphoma. Once bound to the CD30+ cells BV exerts its cytotoxic effect via the monomethyl-auristatin-E moiety. So far, accounts on immediate adverse reactions to BV remain anecdotal. Moreover, few reports exist on desensitization for BV. CASE PRESENTATION: A 20-year old male patient was diagnosed with Hodgkin lymphoma in July 2014. The first line treatment with adriblastine, bleomicine, vinblastine and dacarbazine lead to a partial remission. Thus, a treatment with BV was started. However, during the second BV infusion, he developed generalized urticaria and dyspnea. In order not to discontinue the treatment with BV, we performed a thorough allergological workup and designed a 12-step rapid desensitization protocol. Overall the desensitization procedure was well tolerated and no major adverse reactions occurred. CONCLUSION: Rapid desensitization is a suitable and safe option in the case of BV allergy and prevents the BV treatment withdrawal.
