Vol. 70 No. 3 (2023), Abstract
Vol. 70 No. 3 (2023)

Desensitization to Rituximab in a patient with persistent proteinuria secondary to SLE

Abstract
Published 2023-08-21
Nayeli Servín Suarez
Instituto Mexicano del Seguro social
Alicia Méndez Gómez
Alergía e Inmunología Clínica, Departamento de Alergia e Inmunología Clínica Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
Karla Korkowski-Uviña
Alergía e Inmunología Clínica, Departamento de Alergia e Inmunología Clínica Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
Hector Carrillo Murillo
Alergía e Inmunología Clínica, Departamento de Alergia e Inmunología Clínica Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
Eduardo Torres Rojo
Alergía e Inmunología Clínica, Departamento de Alergia e Inmunología Clínica Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
Margarita Ortega Cisneros
Alergía e Inmunología Clínica, Departamento de Alergia e Inmunología Clínica Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
Itzel Vianey Ochoa García
Alergía e Inmunología Clínica, Departamento de Alergia e Inmunología Clínica Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
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Keywords

Key words: desensitization, rituximab, protocol, reaction, hypersensitivity.

How to Cite

Desensitization to Rituximab in a patient with persistent proteinuria secondary to SLE. (2023). Revista Alergia México , 70(3), 197. https://doi.org/10.29262/ram.v70i3.1288
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Abstract

ABSTRACT

Background: Rituximab is a chimeric monoclonal anti-CD20 antibody, used as a treatment option against lymphoproliferative disorders and rheumatic diseases; hypersensitivity reactions (RHS) are related with infusion, cytokine release or type I (IgE/Non IgE), mixed, type III and type IV reactions. Desensitization induces temporary tolerance diminishing probability of reactions by gradually incrementing the dose to reach therapeutic dose, targeting basophils and mast cells and preventing their activation.

Case report: We present a personalized desensitization protocol in a 36 year old female patient with Systemic Lupus Erythematosus (LES) previously treated with rituximab in 2019, receiving 4 doses,10 minutes after 4th dose, presenting dyspnea, laryngeal edema, chest pain, angioedema and neurological alterations. She requires further administration of rituximab due to persistent proteinuria LES related.

After negative prick test, we perform 3-bag, 13-step desensitization protocol for rituximab (bag A: [1:100], B [1:10], C [1:1]). It is well known that only 52% of RHS results in a positive prick test, and by the clinical picture presented by the patient previously, we decide to perform desensitization. Reaching a rituximab 897.87mg cumulative dose in a 5 hour period, with no complications during nor after the procedure, concluding successfully.

Conclusion: By performing desensitization of a culprit drug in previously sensitized patient, we offer a safe therapeutic option when this is the treatment of choice and benefits of the culprit outweight the risk.

Key words: desensitization, rituximab, protocol, reaction, hypersensitivity.

 

Autor de correspondencia: Nayeli Servín Suárez, nayeliservinsz@gmail.com

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References

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