Glatiramer acetate: successful desensitization for treatment of multiple sclerosis.

BACKGROUND: Glatiramer acetate is an immunomodulatory drug that is widely prescribed for the treatment of multiple sclerosis. It is frequently associated with local injection site reactions and generalized urticaria. It is also associated with immediate postinjection systemic reactions in approximately 10% of patients. To our knowledge, no desensitization protocols for glatiramer acetate have been published to date. OBJECTIVES: To evaluate the safety and efficacy of glatiramer acetate desensitization in a series of patients with multiple sclerosis. METHODS: Six patients with multiple sclerosis and glatiramer acetate-associated local or systemic reactions underwent a 4-hour outpatient desensitization procedure at Cleveland Clinic between 2003 and 2008. Beginning with 20 ng, we administered subcutaneous glatiramer acetate suspension in increasing dosages every 15 minutes. Patient outcomes were monitored by return clinic visit and telephone follow-up. RESULTS: No episodes of anaphylaxis or serious adverse reactions occurred during or immediately after desensitization. One patient suspended therapy after 14 months due to persistent local injection site reactions. All other patients successfully continued glatiramer acetate therapy. CONCLUSION: Glatiramer acetate offers significant benefit to patients with multiple sclerosis. Our experience suggests that patients who suspend its use owing to local or systemic reactions can be successfully and safely desensitized and can resume medication use. To our knowledge, this is the first report of successful desensitization to glatiramer acetate in patients with multiple sclerosis.

Food allergy is associated with potentially fatal childhood asthma.

BACKGROUND: Risk factors for potentially fatal childhood asthma are incompletely understood. OBJECTIVE: To determine whether self-reported food allergy is significantly associated with potentially fatal childhood asthma. STUDY DESIGN: Medical records from 72 patients admitted to a pediatric intensive care unit (PICU) for asthmatic exacerbation were reviewed and compared in a case-control design with 2 randomly selected groups of 108 patients admitted to a regular nursing floor for asthma and 108 ambulatory patients with asthma. Factors evaluated included self-reported food allergy, gender, age, poverty area residence, race/ethnicity, inhaled steroid exposure, tobacco exposure, length of hospital stay, psychologic comorbidity, and season of admission. RESULTS: At least one food allergy was documented for 13% (38/288) of the patients. Egg, peanut, fish/shellfish, milk, and tree nut accounted for 78.6% of all food allergies. Children admitted to the PICU were significantly more likely to report food allergy (p = 0.004) and 3.3 times more likely to report at least one food allergy compared with children admitted to a regular nursing floor, and significantly more likely to report food allergy (p < 0.001) and 7.4 times more likely to report at least one food allergy compared with children seen in the ambulatory setting. Children admitted to either the PICU or the regular nursing floor were significantly more likely be African-American (p < 0.001) and to be younger (p < 0.01) compared with children seen in the ambulatory setting. CONCLUSIONS: Self-reported food allergy is an independent risk factor for potentially fatal childhood asthma. Asthmatic children or adolescents with food allergy are a target population for more aggressive asthma management.

Pediatric hypereosinophilic syndrome (HES) differs from adult HES.

The idiopathic hypereosinophilic syndrome (HES) developed in a 15-year-old boy who presented with colitis, cough, rash, and hepatitis. Molecular analysis failed to demonstrate the Fip1-like1-Platelet Derived Growth Factor Receptor alpha chain (FIP1L1-PDGFRA) mutation described in adult patients with HES. There are significant clinical differences between the pediatric and adult presentations of HES.