Successful Rapid Drug Desensitization with A Modified Protocol To Alemtuzumab in A Multiple Sclerosis Patient with Severe Immediate-Type Hypersensitivity Reaction

Alemtuzumab is a humanized monoclonal antibody targeting the CD52 antigen on lymphocyte surfaces. The intravenous administration of alemtuzumab provokes the depletion of lymphocytes by antibody-dependent and complement-mediated cellular cytotoxicity. Resulting cytotoxicity leads to 'first-dose...

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Bibliographic Details
Published inNoro-Psikiyatri Arsivi Vol. 59; no. 3; pp. 237 - 241
Main Authors Dalgic, Ceyda Tunakan, Gokmen, Emine Nihal Mete, Ozisik, Melih, Baklan, Meltem Alkaya, Yuceyar, Nur
Format Journal Article
LanguageEnglish
Published Ankara AVES 01.09.2022
BAYT Ltd. Co
Noro-Psikiyatri Arsivi
Subjects
Allergies
Binding sites
Cardiac arrhythmia
Care and treatment
Case Report
Case studies
Cytokines
Cytotoxicity
Desensitization (Psychology)
Drug allergy
Drug dosages
Drug therapy
Edema
Erythema
Fever
Histamine
Hypertension
Hypotension
Monoclonal antibodies
Multiple sclerosis
Nausea
Patients
Pruritus
Tumor necrosis factor-TNF
Urticaria
Vomiting
Turkey
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Summary:Alemtuzumab is a humanized monoclonal antibody targeting the CD52 antigen on lymphocyte surfaces. The intravenous administration of alemtuzumab provokes the depletion of lymphocytes by antibody-dependent and complement-mediated cellular cytotoxicity. Resulting cytotoxicity leads to 'first-dose infusion-related reactions in more than 90% of the patients, fewer than 3% being severe cases. We present the first successful modified rapid drug desensitization (RDD) protocol to alemtuzumab in an active relapsing-remitting multiple sclerosis (RRMS) patient. The forty-year-old female patient had an immunologically-mediated mixed-type (co-occurring IgE-mediated and cytokine release syndromes) hypersensitivity reaction (HSR) verified with a drug skin test. As the patient had severe HSR and there was no other option to treat RRMS at that time; two courses of 12 mg alemtuzumab with one-year intervals were administrated successfully using the modified 12-step intravenous RDD protocol. By experience, RDD is known as a safe and effective therapy option allowing alemtuzumab treatment targeted for the aforementioned type of MS. Keywords: Alemtuzumab, multiple sclerosis, rapid drug desensitization, hypersensitivity reaction, skin test
ISSN:1300-0667
1309-4866
DOI:10.29399/npa.27371