title: Successful desensitization to natalizumab in a skin test--positive patient: a case report.
abstract: Relevant interest has been focused on rapid desensitization for drug hypersensitivity and on its use for reactions to monoclonal antibodies. Natalizumab is a highly effective therapy for multiple sclerosis but its use can be limited by hypersensitivity reactions. Herein we present a case of a 36-year-old male patient with multiple sclerosis who started natalizumab therapy due to rapid neurological deterioration. During the second infusion he developed a reaction involving urticaria, erythema and angioedema. Natalizumab sensitization was demonstrated by a positive result on the intradermal test. The anti-natalizumab IgG neutralizing antibody assay was negative. Lacking any alternative, equally effective treatment, he underwent a rapid intravenous desensitization protocol. Desensitization was successfully repeated eleven times and the patient's neurological conditions improved and remained stable after one year. This case demonstrates that rapid desensitization is a safe and effective procedure in the treatment of natalizumab hypersensitivity.
authors.affiliation: Allergy Unit, San Martino Hospital, Genoa, Italy. donatella.bignardi@hsanmartino.it
authors.forename: D
authors.initials: D
authors.lastname: Bignardi
authors.forename: G
authors.initials: G
authors.lastname: Ribizzi
authors.forename: S
authors.initials: S
authors.lastname: Voltolini
authors.forename: C
authors.initials: C
authors.lastname: Serrati
authors.forename: C
authors.initials: C
authors.lastname: Troise
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy; D000069442:Natalizumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab