Modified Desensitization Protocols for a Pediatric Patient with Anaphylactic Reaction to Deferoxamine
Pacharapan Surapolchai MD*, Orapan Poachanukoon MD*, Wallee Satayasai MD*, Pakatip Silapamongkonkul MD*
Affiliation : * Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Thalassemia major is an inherited form of chronic hemolytic anemia that results in iron overload due to regular blood transfusions. Deferoxamine is used as chelating agent for treatment of patients with chronic iron overload worldwide. Anaphylactic reaction to deferoxamine is rare, and the mechanism of deferoxamine-induced anaphylaxis is not well understood. Only a few pediatric cases of successful desensitization for deferoxamine hypersensitivity have been described, and a different protocol has been used in each report. We report a case of anaphylaxis to deferoxamine in a thirteen-years-old Thai boy with Hemoglobin E/β-thalassemia disease who underwent successful desensitization. He had been receiving blood transfusions since the age of ten months. At age eleven, the patient began treatment with deferoxamine. Treatment was interrupted after the occurrence of anaphylaxis, with urticaria, wheezing and gastrointestinal symptoms. A skin prick test was positive, indicating a type 1 hypersensitivity reaction. Deferoxamine desensitization was attempted with various different protocols. Finally, the patient could tolerate deferoxamine therapy at the dose previously administered. We proposed this modified subcutaneous desensitization protocol for pediatric cases that develop allergic reactions to deferoxamine.
Keywords : Deferoxamine, Anaphylaxis, Desensitization, Subcutaneous
