Basa Akdogan Buket, Koca Kalkan Ilkay, Koycu Buhari Gozde, Ozdedeoğlu Ozlem, Ates Hale, Aksu Kurtulus, Oner Erkekol Ferda
University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, and.
Yıldırım Beyazıt University, Division of Immunology and Allergy, Department of Chest Diseases, Ankara, Türkiye.
Allergol Select. 2024 Aug 19;8:278-282. doi: 10.5414/ALX02501E. eCollection 2024.
When deferasirox is used in iron chelation therapy, maculopapular rash occurs in 10% of patients, but there is no accepted and implemented protocol for the management of these drug reactions in adults.
A 23-year-old woman diagnosed with thalassemia major is presented. She had taken 1,500 mg oral deferasirox for 1 week. Five hours after the last dose, a pruritic maculopapular rash developed on the body, face, and hands. The rash spread to the whole body within 3 days. The absolute necessity for the patient to take the drug was clarified by the hematology department. The patient's history was evaluated. A delayed-type hypersensitivity reaction due to deferasirox was considered.
The slow desensitization protocol described in the literature and applied on a case-by-case basis in pediatric patients was modified to shorten the duration by determining appropriate doses for the current preparation. The desensitization process was started with 1/100,000 of the total dose and the therapeutic dose was reached with a 2- to 2.5-fold increase in dose. No pre-medication was applied. During the procedure, at a low dose of 0.1 mg, local flushing and erythema was observed around the auricle on the face. The reaction did not progress.
Slow desensitization protocol for oral deferasirox was successfully applied in an adult patient.
当去铁胺用于铁螯合治疗时，10%的患者会出现斑丘疹，但目前尚无针对成人这些药物反应的公认且实施的管理方案。
介绍了一名23岁被诊断为重型地中海贫血的女性。她口服1500毫克去铁胺1周。最后一剂后5小时，患者身体、面部和手部出现瘙痒性斑丘疹。皮疹在3天内蔓延至全身。血液科明确了患者服用该药物的绝对必要性。对患者病史进行了评估。考虑为去铁胺引起的迟发型超敏反应。
对文献中描述的、在儿科患者中逐案应用的缓慢脱敏方案进行了修改，通过确定当前制剂的合适剂量来缩短疗程。脱敏过程从总剂量的1/100,000开始，剂量以2至2.5倍的幅度增加直至达到治疗剂量。未进行预处理。在该过程中，当剂量为0.1毫克时，面部耳廓周围观察到局部潮红和红斑。反应未进展。
口服去铁胺的缓慢脱敏方案在一名成年患者中成功应用。
