Cyclosporine-induced anaphylaxis

OBJECTIVE: To describe a case of an anaphylactic reaction after first inges tion of oral cyclosporine capsules (Neoral). CASE SUMMARY: A 73-year-old white woman was admitted for the treatment of m etastatic breast carcinoma wit an experimental oral paclitaxel solution com bination wit cyclosporine capsules. After ingestion of the cyclosporine cap sules, the patient collapsed within one hour. She initially experienced sev ere hypotension and bradycardia. After a few minutes, she developed severe tachycardia, dyspnea, and decreased consciousness. Administration of epinep hrine, dexamethasone, clemastine, oxygen, and gelofusine (succinylated gela tin 4% in NaCl 0.9%) infusion resulted in complete recovery after several h ours. The planned oral paclitaxel administration was canceled. Intravenous paclitaxel was given the next day, preceded by standard premedication with dexamethasone, clemastine, and cimetidine, without complications. DISCUSSION: To ur knowledge, this is the first report in the literature of an anaphylactic reaction after oral ingestion of cyclosporine capsules. Ear lier reports of anaphylaxis concerned intravenous cyclosporine or oral solu tions of cyclosporine (both Sandimmune). These anaphylactic reactions were considered to be due to the pharmaceutical vehicle Cremophor EL or related substances, which are well-known causes of anaphylaxis. The capsules used i n this case contain the Cremophor EL-related polyoxyl 40 hydrogenated casto r oil as a base or patient's anaphylactic shock may have been due to this s ubstance. CONCLUSIONS: In addition to earlier reports about anaphylactic reactions af ter administration of an intravenous or oral solution of cyclosporine, this case shows that anaphylactic shock can occur after ingestion of cyclospori ne capsules.