Abstract
Introduction: In many cases of drug allergy, it is necessary to do in vitro test, for several reasons. BAT (basophil activation test) is a very useful weapon in these cases. In many iv. or im. depot preparations, the culprit of the allergic reaction is an excipient, and not the main component.
Case report: A 37-year-old male, suffering from a Klinefelter syndrome needed treatment with a preparation of undecanoate of testosterone (Reandron). With the last administered dose, he suffered an anaphylactic shock with Kounis syndrome. The patient declined any in vivo studies, so we thought of BAT as a possibility for the diagnosis. The results were remarkable, showing a very high positivity to castor oil.
Conclusions: This is the second case in the world of anaphylaxis to a preparation of Testosterone, and the first one with the castor oil (also called Cremophor or Kolliphor) as responsible. El BAT was essential for the diagnosis and ulterior treatment of this patient. This is the first time, that this study with BAT, has been done with a Testosterone preparation.
References
Schubert M, Minneman T, Hübler D, Rouskova D, Christoph A, Oettel M, et al. Intramuscular testosterone undecanoate: pharmacokinetic aspects of a novel testosterone formulation during long-term treatment of men with hypogonadism. J Clin Endocrinol Metab. 2004;89:5429-5434. DOI: 10.1210/jc.2004-0897
Hausmann OV, Gentinetta T, Bridts CH, Ebo DG. The basophil activation test in immediate -type drug allergy. Immunol Allergy Clin North Am. 2009;29:555-66. DOI: 10.1016/j.iac.2009.04.011
Hoffmann HJ, Santos AF, Mayorga C, Nopp A, Eberlein B, Ferrer M, et al. The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease. Allergy. 2015;70:1393-1405. DOI: 10.1111/all.12698
Riffkin C, Huber R, Keysser CH. Castor oil as a vehicle for parenteral administration of steroid hormones. J Pharm Sci. 1964;53:893-395. DOI: 10.1002/jps.2600530809
Reiner R, Breynaert C, Dens A-C, et al. Allergic reactions to polyethoxylated castor oil derivatives: A guide to decipher confusing names on pharmaceutical labels. J Allergy Clin Immunol Pract. 2020;8::1136-1138. DOI: 10.3892/mmr.2013.1264
Caballero ML, Quirce S. Immediate hypersensitivity reactions caused by drug excipients: a literature review. J Investig Allergol Clin Immunol. 2020;30:86-100. DOI: 10.18176/jiaci.0476
Dye D, Watkins J. Suspected anaphylactic reaction to Cremophor EL. Br Med J. 1980;280:1353. DOI: 10.1136/bmj.280.6228.1353
Hüttel MS, Schou-Olesen A, Stoffersen E. Complement-mediated reactions to diazepam with Cremophor as solvent (Stesolid MR). Br J Anaesth. 1980;52:77-79. DOI: 10.1093/bja/52.1.77
Ebo DG, Piel GC, Conraads V, Stevens WJ. IgE-mediated anaphylaxis after first intravenous infusion of cyclosporine. Ann Allergy Asthma Immunol. 2001;87:243-245. DOI: 10.1016/S1081-1206(10)62234-X
Ong GSY, Somerville CP, Jones TW, Walsh JP. Anaphylaxis triggered by benzyl benzoate in a preparation of depot testosterone undecanoate. Case Rep Med. 2012;2012:384054. DOI:10.1155/2012/384054
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2021 Revista Alergia México