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Cyclophosphamide type I hypersensitivity in systemic lupus erythematosus.
B Y H Thong1, K P Leong, J Thumboo
1Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore. bernard_thong@ttsh.com.sg
Lupus
|April 18, 2002
Summary
Hypersensitivity reactions to intravenous cyclophosphamide (i.v. CYC) are rare in rheumatology. This case shows that i.v. CYC can be safely continued with antihistamine pre-medication in patients with mild reactions.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Cyclophosphamide (CYC) is a vital immunosuppressant for rheumatic diseases.
- Previous reports of hypersensitivity to i.v. CYC are primarily in oncology patients.
- Type I hypersensitivity reactions, including urticaria and anaphylaxis, can occur.
Observation:
- A case of generalized urticaria following monthly i.v. CYC in an 18-year-old with systemic lupus erythematosus (SLE).
- The patient had a history of life-threatening angioedema from a respiratory infection.
- No anaphylaxis or angioedema occurred during i.v. CYC treatment.
Findings:
- This is the first reported case of type I hypersensitivity (urticaria) to i.v. CYC in the rheumatology literature.
- The patient successfully tolerated subsequent i.v. CYC infusions with antihistamine pre-medication.
- The reaction was managed effectively, allowing continued treatment.
Implications:
- Intravenous cyclophosphamide can be safely administered in rheumatology patients with mild hypersensitivity reactions.
- Antihistamine pre-medication and careful monitoring are crucial for managing i.v. CYC-induced urticaria.
- This approach may allow continued use of i.v. CYC when alternative immunosuppressants are unsuitable or less effective.