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Oral Desensitization Prevents Recurrent Imatinib Rash
NEW YORK (Reuters Health) Aug 31 - Oral desensitization can be used to
prevent the recurrent rash that prevents therapy with imatinib in some
patients with leukemia, according to a report in the August Annals of
Allergy, Asthma & Immunology.
"A single case has been reported of a protracted, progressive challenge
using weekly dosing increments, but no universally established algorithm
exists for managing patients with adverse cutaneous reactions to imatinib,"
the authors explain.
Dr. Robert P. Nelson, Jr. and colleagues from Indiana University School of
Medicine, Indianapolis, administered oral desensitization to 10 patients
with leukemia who had a prior history of refractory rash associated with
imatinib.
The 4-hour oral desensitization program started with a 10 ng dose in a
supervised setting and progressed in nine steps to tablets of 2 to 100 mg,
the report indicates.
All 10 patients tolerated the oral desensitization program, the authors
report, and 8 patients were able to continue daily imatinib therapy without
recurrent rash or other adverse effects.
Of the two remaining patients, one developed a diffuse rash 5 hours after
the desensitization procedure, and one developed recurrent rash several days
after desensitization.
"Observations of greater numbers of patients who undergo this procedure will
be required to confirm the efficacy of oral desensitization and to
illuminate the mechanism of rash development in patients with recurrent or
recalcitrant rash," the researchers say.
"Oral desensitization appears to be an option for patients with recurrent
cutaneous drug reactions to imatinib, which may permit clinicians to safely
administer imatinib to some patients with leukemia who experience adverse
cutaneous reactions to this life-prolonging medication," the investigators
conclude.
Ann Allergy Asthma Immunol 2006;97:216-222.
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