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Successful desensitization to high-dose methotrexate after systemic anaphylaxis
Kepler A Davis1, Patrick Williams, John C Walker
1Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA. Kepler.Davis@amedd.army.mil
Summary
This study details the first successful desensitization protocol for high-dose methotrexate (MTX) in osteosarcoma patients experiencing anaphylaxis. This breakthrough allows patients with MTX hypersensitivity to receive essential chemotherapy.
Area of Science:
- Oncology
- Pharmacology
- Allergy and Immunology
Background:
- High-dose methotrexate (MTX) is a critical adjuvant chemotherapy for osteosarcoma.
- MTX, a folic acid antagonist, is associated with known toxicities, including anaphylaxis.
- Anaphylactic reactions to MTX necessitate alternative treatment strategies or desensitization protocols.
Observation:
- A 22-year-old osteosarcoma patient experienced immediate hypersensitivity during high-dose MTX infusion.
- Symptoms included urticaria, facial swelling, cough, and chest tightness, leading to infusion termination.
- Skin testing confirmed MTX allergy, posing a challenge for necessary adjuvant chemotherapy.
Findings:
- A novel desensitization protocol was developed and successfully administered in an intensive care unit setting.
- The protocol involved pretreatment with multiple antihistamines and corticosteroids.
- The patient underwent repeated MTX infusions without incident, with low serum tryptase levels indicating controlled mast cell degranulation.
Implications:
- This represents the first successful desensitization protocol for high-dose MTX.
- The protocol offers a viable option for osteosarcoma patients with MTX-induced anaphylaxis.
- Enables continuation of life-saving or palliative chemotherapy for patients with MTX hypersensitivity.