Intravenous cyclosporine and tacrolimus caused anaphylaxis but oral cyclosporine capsules were tolerated in an allogeneic bone marrow transplant recipient

Citation
Y. Takamatsu et al., Intravenous cyclosporine and tacrolimus caused anaphylaxis but oral cyclosporine capsules were tolerated in an allogeneic bone marrow transplant recipient, BONE MAR TR, 28(4), 2001, pp. 421-423
Citations number
18
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
Journal title
BONE MARROW TRANSPLANTATION
ISSN journal
02683369 → ACNP
Volume
28
Issue
4
Year of publication
2001
Pages
421 - 423
Database
ISI
SICI code
0268-3369(200108)28:4<421:ICATCA>2.0.ZU;2-Z
Abstract
A Japanese female patient with angioimmunoblastic T cell lymphoma underwent allogeneic bone marrow transplantation (BMT) from her brother. Cyclosporin e at a dose of 3 mg/kg was started by continuous infusion over 24 h on day -1 of BMT. Within a couple of minutes after the infusion was begun, she dev eloped diffuse pruritic erythema on her whole body and tachycardia. The inf usion was immediately stopped and corticosteroid was given, resulting in di sappearance of the erythema gradually. She was then switched to intravenous tacrolimus. However, she suffered urticalial erythema again. Since polyoxy ethylated castor oil, a solubilizer used in the injective formulation of bo th cyclosporine and tacrolimus, is considered to be responsible for the rea ction, she was given oral capsules of cyclosporine (Sandimmun) in which pol yoxyethylated castor oil was not contained. No further anaphylactic reactio n was observed. The BM cells were successfully engrafted without causing se vere GVHD. She was discharged on cyclosporine capsules without any further adverse effects. Anaphylaxis to intravenous cyclosporine and tacrolimus is a very rare but a serious complication. Our present case indicates that ora l capsule of Sandimmun is a safe alternative to prevent GVHD in such a case of anaphylactic reaction against intravenous formulation.