Allergic reactions desensitization

Allergic reactions to insulin include erythema, pruritus, and indurations,22 which usually are transient. For the more troublesome reactions, treatment options include dexamethasone, desensitization, or change in delivery system (i.e., insulin pump or inhaled insulin). 

A generalized allergic reaction to human menopausal gonadotropin (Pergonal) has been described during controlled ovarian hyperstimulation (40). In this case a desensitization protocol allowed the patient to complete her treatment cycle without further problems. Subsequently recombinant follicle stimulating hormone was used successfully and uneventfully. 

Systemic allergic reactions to somatropin are very rare, but can be overcome by desensitization (SEDA-13,1308 86). Although early studies suggested a higher rate of renal transplant rejection in recipients of somatropin than in controls (SEDA-21, 452), this was not confirmed in a long-term prospective study (87). 

Aside from the fact that chemical substances make them sick, some MCS patients also develop allergies and food intolerances. It s best to let yourself be treated by a therapist or doctor who can test for such things. Here, too, avoidance is the best medicine, as opposed to using all sorts of medications intended to suppress the allergic reactions (although in cases of anaphylactic shock, medicine is a matter of life and death ). Allergy and food intolerance treatment now includes a number of methods, such as low-dose antigen therapy (LDA), enzyme-potentiated desensitization (EPD neutralization injections) and the provocation/neutralization method (injections). 

Allergic reactions to mercaptopurine or azathioprine are well described, but a true immunoallergic reaction has never been convincingly demonstrated. Desensitization has been successfully performed in isolated patients (47), and this has been more extensively addressed in a retrospective analysis of the charts of patients treated for... 

Dextran 70, so-called because its molecules have an average weight of 70 kDa, is used as a plasma substitute, as is dextran 40. Dextran 40 has been used to improve blood flow in ischemic limbs. Dextran 40 and dextran 70 have been used to prevent deep venous thrombosis. Dextran 1 is used as a desensitizer to prevent allergic reactions to dextrans of larger molecular weight. After reproductive surgery 32% dextran 70 is sometimes administered... 

The incidence of allergic reactions to efavirenz is 10-34%. They usually cause an erythematous maculopapular rash, with or without fever, 1-3 weeks after the start of therapy. Desensitization has been reported (19). 

The risks of desensitization have to be set against the chance of benefits. The dominant risk is that of an allergic reaction. Subcutaneous injection of allergenic extracts can lead variously to ... 

The efficacy of desensitization using subcutaneous maintenance venom immunotherapy is well established and is usually considered in patients with severe systemic allergic reactions to both yellow jacket and bee venom (grade III or IV according to Mueller). 

Treatment of these problems is by substituting another insulin species which does not cross-react with the antibodies, by desensitization, or by local or systemic administration of glucocorticoids. If a severe allergic reaction occurs, the drug has to be discontinued and the patient treated with the usual agents (e.g. adrenaline, antihistamines or corticosteroids). Patients who have experienced severe systemic allergic symptoms should be skin-tested with another insulin preparation before its initiation. Desensitization procedures may permit resumption of insulin administration. 

Adverse effects that are not dose related most commonly include rash, fever, or hepatotoxicity, as well as relatively uncommon but serious reactions such as bone marrow suppression, thrombocytopenia, pancreatitis, and hepatitis. For most patients with idiosyncratic reactions, sulfasalazine must be discontinued. In some patients who have experienced allergic reactions to sulfasalazine, a desensitization procedure can be instituted. By gradually increasing sulfasalazine dosage over weeks to months, patient tolerance has been improved. Most of the idiosyncratic reactions observed with sulfasalazine are similar to those with the class of sulfonamides in general. 

Occasional patients have antibodies to injected insulin, but the significance of the antibodies is minimal. Human insulin therapy has not totally eliminated insulin allergies, although most patients have a local reaction that will dissipate over time. If the allergic reaction does not improve or is systemic, insulin desensitization can be carried out. Protocols for desensitization are available from major insulin manufacturers. While more common in the animal insulin era, lipohypertrophy is still seen in some patients with longstanding type 1 DM. Such patients give their insulin injections in the same site to minimize discomfort. Because insulin absorption from an area of lipohypertrophy is unpredictable, avoidance of injections into these areas is mandatory. 

Penicillin desensitization should be performed in a hospital setting where resuscitation equipment is readily available by a physician experienced in the risks and management of severe allergic reactions. The potential risks and benefits should be discussed with the patient. Prior to initiating the protocol, the patient should be stabilized and fluid, pulmonary, and cardiovascular function optimized. The use of... 

Results of therapeutic approach in patients with systemic insulin allergy are given by Mattson et al. (12). Desensitization was successful in 12 patients who needed insulin. In these patients insulin therapy had been stopped because of allergic reactions to insulin, often many years previously. Eight patients had elevated IgE levels at the start of therapy. With desensitization IgE levels declined rapidly. 

The benefit to harm balance in desensitization treatment was examined in a meta-analysis published in 1995, covering 20 randomized, placebo-controlled, doubleblind trials of allergen immunotherapy for asthma. Systemic reactions occurred in a mean of 32% (20-44%) of patients, but anaphylaxis was reported on only four occasions. It was concluded that immunotherapy was a treatment option in highly selected patients with extrinsic allergic asthma where a clinically relevant and unavoidable allergen is identified (7). 

Procedure Beta-lactam desensitization should be done in an intensive care unit and any concomitant risk factors for anaphylaxis, such as use of beta-blockers should be corrected. Protocols based on incremental use of the drug orally or parenterally have been described (190,193). The oral route is preferable and is associated with a lower incidence of adverse events, but mild transient reactions are frequent (171,194,195). Pregnant women with limited antibiotic choices have been treated with immunotherapy (196). Repeated administration will maintain a state of anergy, which is often lost after withdrawal (197). At the conclusion of therapy, patients must be informed that after withdrawal, they may once again become allergic to penicillin, with a new reaction to the first subsequent application (197). 

Eor some patients allergic to penicillin, no reasonable alternatives exist, and penicillin therapy may be necessary for treatment of severe, life-threatening infection. In this situation, penicillin desensitization should be considered. Desensitization can reduce the risk of anaphylaxis but does not influence the likelihood of other types of reactions such as exfoliative dermatitis or Stevens-Johnson syndrome. 

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