This week on the GI bulletin board there was a brief discussion about overcoming allergic/anaphylactic reactions to infliximab. A reference and a thoughtful response by Athos Bousvaros (in italics) follows:
Inflamm Bowel Dis. 2001 Feb;7(1):34-7. Successful desensitization and therapeutic use of infliximab in adult and pediatric Crohn’s disease patients with prior anaphylactic reaction. Puchner TC, Kugathasan S, Kelly KJ, Binion DG.
1. Premed with 4 days of steroids (1mg/kg up to 40mg), and hydrocortisone day of the infusion.
2. Give two test doses (0.1 mg, 1 mg), each over 10 minutes,
3. If no problems, run the infusion over 4 hours instead of two.
Getting antibodies to infliximab before the challenge may also be helpful. If high levels of antibodies are present, the patient may be more likely to fail the challenge. WE can “rescue” about half our patients using this protocol, and keep them on infliximab. IMPORTANT that a physician is around during the challenge.
Given the potential for adverse reactions and the importance of not depleting useful treatments, it is definitely worthwhile to read the entire cited reference rather than the aforementioned summary.
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