Volcheck G W, Van Dellen R G
Division of Allergy and Outpatient Infectious Disease and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Ann Allergy Asthma Immunol. 1998 Feb;80(2):159-63. doi: 10.1016/S1081-1206(10)62949-3.
Hypersensitivity reactions to cyclosporine are rare. The mechanism of the reaction and guidelines for subsequent use of cyclosporine are not well defined.
To investigate the mechanisms involved in hypersensitivity reactions to cyclosporine and determine the feasibility of future cyclosporine use.
We report a patient who had an anaphylactic reaction during the intravenous infusion of cyclosporine. Skin-prick tests were performed for the antibiotics he received earlier in the day and the cyclosporine. A MEDLINE search identified all the reported cases of hypersensitivity reactions to cyclosporine. Each was analyzed to determine a mechanism of the hypersensitivity reaction and subsequent management outcomes.
Intradermal tests to intravenous cyclosporine formulation (1 mg/mL) were positive in the patient and negative in two controls. There was no reaction to the antibiotics. The literature search revealed 22 cases of hypersensitivity reaction to cyclosporine. The clinical setting and diagnostic evaluation suggest multiple mechanisms for the hypersensitivity response. All seven patients who were given an oral formulation of cyclosporine tolerated it well after a reaction to the intravenous infusion. Two patients who initially reacted to an oral solution formulation subsequently tolerated the corn oil-based soft gelatin capsule.
Hypersensitivity reactions to cyclosporine are due to Cremophor EL. There is direct and indirect evidence for various immunologic and nonimmunologic pathways precipitating the reaction. This case suggests a role for IgE in the hypersensitivity reaction. Fortunately, a hypersensitivity reaction to one formulation of cyclosporine does not preclude use of a different formulation. The corn oil-based soft gelatin capsule appears to be the safest formulation.
对环孢素的过敏反应罕见。该反应的机制以及环孢素后续使用的指南尚不明确。
研究环孢素过敏反应的相关机制，并确定未来使用环孢素的可行性。
我们报告了1例在静脉输注环孢素期间发生过敏反应的患者。对其当天早些时候使用的抗生素及环孢素进行了皮肤点刺试验。通过医学期刊数据库检索确定了所有已报道的环孢素过敏反应病例。对每个病例进行分析以确定过敏反应的机制及后续处理结果。
患者对静脉用环孢素制剂（1mg/mL）的皮内试验呈阳性，两名对照者呈阴性。对抗生素无反应。文献检索发现22例环孢素过敏反应病例。临床情况和诊断评估提示过敏反应存在多种机制。所有7例对静脉输注环孢素发生反应后口服环孢素制剂的患者耐受性良好。2例最初对口服溶液制剂有反应的患者随后对玉米油软胶囊耐受性良好。
环孢素过敏反应是由聚氧乙烯蓖麻油引起的。有直接和间接证据表明各种免疫和非免疫途径引发了该反应。本病例提示IgE在过敏反应中起作用。幸运的是，对一种环孢素制剂的过敏反应并不排除使用另一种制剂。玉米油软胶囊似乎是最安全的制剂。
