Clinical allergy. Managing generalized interferon-induced eruptions and the effectiveness of desensitization.

Abstract

BACKGROUND:

We evaluated the value of skin tests and the efficacy of a 12-step desensitization protocol to pegylated interferon (IFN) in patients with generalized drug eruptions due to IFNs.

METHODS:

A retrospective study (1998-2009) was followed by a cross-sectional clinical study conducted prospectively (2009-2011). All patients received a dermatological clinical examination and skin tests. Twelve-step IFN desensitization was proposed for patient with active hepatitis C and no alternative therapy.

RESULTS:

Twenty-six patients (13 males, mean age, 53.5 years) had generalized reactions to IFNs; 21 were treated with IFN-α and 5 with IFN-β. Moreover, 21 patients had skin tests. Intradermal tests (IDTs) were positive after an average of 72 h. Cross-reactivity between peg-IFN-α2a and peg-IFN-α2b was observed in 5/10 cases in the prospective study. In 16 of 26 cases, IFN treatment was stopped. In 8 of 16 cases of diffuse eczematous drug eruption, treatment was continued. The corticosteroid and antihistamine were sufficient in 4/8 cases. In three other cases, topical tacrolimus was highly effective. In 3 of 16 cases in which treatment were stopped, patients underwent the early resumption of peg-IFN-α. These three patients had positive tests with peg-IFN-α2a and peg-IFN-α2b and successfully completed the tolerance induction protocol for peg-IFN-α2b. Tolerance induction involved a weekly dose of peg-IFN and a gradual increase in the recovery of an antiviral C. Clinical tolerance was excellent, and the patients' viral load C became negative.

CONCLUSIONS:

Our study demonstrates the benefit of allergy testing in cases of generalized drug reactions to IFN, cross-reactivities in a single class of IFNs and the importance of delayed IDT reading. We report for the first time the effectiveness of 12-step desensitization with peg-IFN.

• Authors: C Poreaux, J-P Bronowicki, M Debouverie, J-L Schmutz, J Waton, A Barbaud
• Journal: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (Clin Exp Allergy) Vol. 44 Issue 5 Pg. 756-64 ( 2014) ISSN: 1365-2222 [Electronic] England
• PMID: 24128045 (Publication Type: Journal Article)
• Copyright: © 2013 John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents
• Interferons

Topics

• Adult
• Aged
• Aged, 80 and over
• Antiviral Agents (adverse effects, therapeutic use)
• Cross-Sectional Studies
• Desensitization, Immunologic (methods)
• Drug Eruptions (diagnosis, therapy)
• Female
• Humans
• Interferons (adverse effects, therapeutic use)
• Male
• Middle Aged
• Retrospective Studies
• Skin (pathology)
• Treatment Outcome