Acetylsalicylic acid and montelukast block mast cell mediator-related symptoms during rapid desensitization.
BACKGROUND
Rapid desensitization is a process in which drug-allergic patients receive their target dose in incremental steps, resulting in a state of temporary tolerization. In this manner, first-line therapy can be delivered safely, even in patients who present with severe hypersensitivity reactions (HSRs) to the given agent. A small subset of patients has persistent HSRs during rapid desensitization that can be refractory to antihistamines and corticosteroids.


OBJECTIVE
To increase the safety and tolerability of rapid desensitization by prostaglandin and leukotriene blockade in patients with refractory mast cell mediator-related symptoms.


METHODS
Fourteen adult patients developed HSRs to platinum chemotherapy that persisted during rapid desensitization. All patients had cutaneous symptoms (flushing, pruritus, or urticaria), many with associated systemic reactions. These patients were then pretreated with acetylsalicylic acid, 325 mg orally, and montelukast, 10 mg orally, 2 days before and on the day of desensitization. Response to subsequent desensitizations was assessed by medical record review and was compared with a group of matched historic control patients who received methylprednisolone for HSRs during desensitization.


RESULTS
Seventy-eight desensitizations in 14 patients were performed. Using acetylsalicylic acid and montelukast, 86% of patients (12/14) experienced substantial improvement in symptoms (grade 0.5 vs grade 2.14, P < .0001). Reduction in symptoms during desensitization was also significantly greater than that experienced by historic control patients who received methylprednisolone pretreatment (grade 0.5 vs grade 1.75, P = .0008). All patients received their target dose of chemotherapy, and there were no severe systemic HSRs.


CONCLUSIONS
Pretreatment with acetylsalicylic acid and montelukast lessens the severity of HSRs during rapid desensitization.
Breslow
Rebecca G
RG
Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Caiado
Joana
J
Castells
Mariana C
MC
D000085:Acetates / Q000627:therapeutic use*; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D003110:Colonic Neoplasms / Q000188:drug therapy; D003521:Cyclopropanes; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D008407:Mast Cells / Q000187:drug effects*; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000009:adverse effects / Q000627:therapeutic use; D010051:Ovarian Neoplasms / Q000188:drug therapy; D011804:Quinolines / Q000627:therapeutic use*; D012015:Reference Standards; D013440:Sulfides
D000085:Acetates; D018927:Anti-Asthmatic Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000970:Antineoplastic Agents; D003521:Cyclopropanes; D018836:Inflammation Mediators; D009944:Organoplatinum Compounds; D011804:Quinolines; D013440:Sulfides; C093875:montelukast; D001241:Aspirin