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Related Experiment Videos

Antithymocyte globulin hypersensitivity in bone marrow failure patients.

L Bielory1, R Wright, A W Nienhuis

  • 1Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103-2757.

JAMA
|December 2, 1988
PubMed
Summary

Epicutaneous skin testing can predict anaphylaxis risk in patients receiving equine antithymocyte globulin (ATG). Positive tests in some patients undergoing ATG treatment led to one fatality and one successful desensitization.

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Area of Science:

  • Immunology
  • Allergy and Clinical Immunology
  • Pharmacology

Background:

  • Antithymocyte globulin (ATG), a heterologous equine protein, is used to treat bone marrow failure.
  • Predicting and preventing anaphylactic reactions to ATG is crucial for patient safety.

Observation:

  • Epicutaneous (prick) skin testing was evaluated in 36 patients receiving equine ATG.
  • Three patients had positive epicutaneous tests; one died of anaphylaxis, and another was successfully desensitized.
  • Intradermal testing showed a 96% positive reaction rate to ATG, with no anaphylaxis during treatment.

Findings:

  • Immediate epicutaneous skin testing demonstrated predictive value for anaphylaxis risk.
  • One patient developed a positive epicutaneous reaction 3-12 months after ATG treatment.

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Implications:

  • Epicutaneous skin testing is recommended for all patients receiving or re-treated with heterologous antisera like ATG.
  • Desensitization is advised for patients with positive epicutaneous test results to mitigate anaphylaxis risk.