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Can High Dose Methotrexate be Continued After Severe Hypersensitivity Reaction?
... 87,88 Methotrexate-induced Pneumonitis: Methotrexate hypersensitivity anaphylactoid reactions are rare, even in the oncology literature where the doses used are significantly higher and where rechallenge or desensitization to treat osteosarcoma might be necessary. 89,90 Methotrexate-induced pneumonitis (MIP) is an idiosyncratic hypersensitivity reaction that is significantly more common, with some case series reporting prevalence as high as 12%, although this is chiefly in the rheumatoid arthritis literature. 87,91,92 The prevalence of methotrexate hypersensitivity pneumonitis in patients with CD is more likely between 0.3 and 0.7%, 92 although a recent meta-analysis found that MTX use in rheumatologic and inflammatory bowel disease was not associated with an increased risk of adverse respiratory events (RR, 1.03; 95% CI, 0.9-1.17). ...
Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine, and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the inflammatory bowel disease population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms.
Hypersensitivity reactions to methotrexate are rare, but have been reported. Methotrexate has shown activity against many malignancies, and omission of methotrexate therapy may increase the risk of cancer-related death in some patients. Therefore, rechallenging patients with methotrexate following hypersensitivity may be beneficial. We report a case of a child with metastatic osteosarcoma who experienced a hypersensitivity reaction to high-dose methotrexate and was successfully rechallenged with methotrexate using a 6-hour infusion. Using this regimen, adequate peak methotrexate plasma concentrations were achieved and no further hypersensitivity reactions were noted. Pediatr Blood Cancer © 2013 Wiley Periodicals, Inc.
Pediatric Hematology and Oncology Division, Department of Woman's and Child's Health, Via Gustiniani
- Ã Correspondence To
à Correspondence to: Antonio Marzollo, Pediatric Hematology and
Oncology Division, Department of Woman's and Child's Health, Via
Gustiniani, 3 -35128, Padova, Italy.
E-mail: antonio.marzollo@gmail.com