Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge.

Area of Science:

• Endocrinology
• Allergy and Immunology
• Pharmacology

Background:

• Adult growth hormone (GH) deficiency is rare and necessitates hormone replacement therapy, typically via injection.
• Atopic individuals may exhibit hypersensitivity to somatotropin, potentially causing skin reactions like rashes.
• Previous reports highlight uncommon allergic and non-allergic skin reactions to recombinant human GH.

Observation:

• A 65-year-old atopic woman experienced severe whole-body rashes with Norditropin FlexPro® despite negative skin-prick tests.
• Patch testing revealed positive reactions to gold and nickel, but not the medication itself.
• The patient underwent a supervised, graded-dose challenge with intravenous Norditropin® in an intensive care unit setting.

Findings:

• The graded-dose challenge was successfully completed without any adverse drug reactions, including skin eruptions.
• The patient was subsequently maintained on Norditropin FlexPro® at a low dose without recurrence of symptoms.
• This marks the first documented successful graded-dose challenge for GH replacement therapy in an adult patient.

Implications:

• Graded dose challenges with somatotropin analogs may be a viable option for adult patients with isolated GH deficiency, including those with atopy.
• This approach could enable more patients to receive necessary GH replacement therapy safely.
• Further research into managing hypersensitivity reactions to GH therapy is warranted.