7
`
`ABSTRACT BOOK
`
`2003 Annual Meeting
`American College of Allergy, Asthma & Immunology
`November 7-12, 2003
`New Orleans
`
`Section 1 contains all abstracts accepted for presentation at Concurrent
`Sessions, Sunday & Monday, November 9-10, 2003
`
`Section 2 contains all abstracts accepted for presentation at Poster
`Sessions, Saturday & Sunday, November 8-9, 2003
`
`Index of Oral and Poster Abstract Authors
`
`VOLUME 92, JANUARY, 2004
`
`99
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`Page 1 of 2
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`YEDA EXHIBIT NO. 2091
`MYLAN PHARM. v YEDA
`IPR2015-00644
`
`

`
`ABSTRACTS: POSTER SESSIONS
`
`followed by urticaria within 30 minutes of Cpxn administration. The patient
`had tolerated daily Cpxn for 2-3 months without untoward reaction. He sought
`emergency department management for this reaction, where he received epi-
`nephrine, diphenhydramine, and nebulized bronchodilator. He responded well
`to this treatment, was discharged home, and suspended Cpxn. He was evalu-
`ated approximately 2 months later. Skin testing was carried out. He had no
`wheal/flare reaction to full strength Cpxn at percutaneous level. There was a
`1-2+ reaction to Cpxn (1/100 dilution) at intradermal level. Although this may
`have reflected an “irritant” response, IgE-mediated potential could not be
`excluded. He underwent subcutaneous desensitization as shown in Table I
`without adverse reaction and has tolerated daily Cpxn for more than 6 months.
`Conclusion: Copaxone is a polymer that has offered significant benefit to
`patients with MS. Our experience suggests that patients who have suspended
`Cpxn because of urticaria can be successfully and safely desensitized, and
`resume Cpxn use. To our knowledge, this is the first report of successful desen-
`sitization to Cpxn in patients with MS.
`
`P157
`SAFETY AND EFFICACY OF MONTHLY CARBOPLATIN
`DESENSITIZATION.
`M. Morgan,* D.A. Khan, R.S. Gruchalla, Dallas, TX.
`Introduction: Hypersensitivity reactions to carboplatin (CBDCA) have
`been well documented in children and adults and may be increasing in fre-
`quency as use of this important antineoplastic drug increases. Protocols for
`desensitization have been described; most reported cases have been success-
`fully rechallenged, but rare failures and even fatalities have also been reported.
`Methods: We report a case of hypersensitivity to carboplatin in a 4 year-old
`female with low-grade medullary pilocytic astrocytoma, which had been
`responding to monthly scheduled carboplatin and vincristine. After 25 min-
`utes of her eighth carboplatin infusion, she mounted a reaction consisting of
`diffuse flushing, facial edema, urticaria, and chest tightness. A desensitization
`protocol with escalating doses of carboplatin was designed for all subsequent
`infusions. Results: The patient tolerated the desensitization procedure well.
`A premedication regimen consisted of H1 and H2 antihistamines, steroids, and
`a leukotriene antagonist. She subsequently completed an additional 7 monthly
`courses of carboplatin along with vincristine. Minor symptoms of facial flush-
`ing and eyelid erythema were treated with H1 antihistamines and steroids; these
`were not judged severe enough to warrant discontinuation, in contrast to the
`initial reaction. For these minor breakthroughs, the preceding dose in the pro-
`tocol was repeated and subsequently added to the following month’s course.
`Frequency and severity of breakthrough reactions decreased as these repeat
`doses were interpolated into the protocol. The final desensitization protocol
`is shown in the table. Follow-up MRI revealed further decrease in tumor size
`after several carboplatin courses facilitated by desensitization. Conclusion:
`The desensitization protocol described successfully delivered carboplatin
`despite a prior serious reaction to this agent. Adaptation of the protocol for
`breakthrough symptoms was also successfully demonstrated. Although the
`mechanisms of carboplatin hypersensitivity and desensitization remain unclear,
`overall safety and efficacy for carboplatin desensitization can be applied to
`repeated monthly courses.
`
`P155
`DESENSITIZATION OF A PATIENT WITH GROWTH HOR-
`MONE HYPERSENSITIVITY.
`P. Shah,* S. Ramesh, Buffalo, NY.
`Introduction Hypersensitivity to growth hormone is extremely rare. There
`are unfortunately no standardizations available for skin testing or for densen-
`sitization to growth hormone. We report of a patient with an urticarial reac-
`tion to growth hormone that underwent skin testing and subsequent desensi-
`tization. Methods
`A 13 y.o. female w
`hormone deficiency was started on growth hormone replacement with Nutropin
`(somatropin, Genentech, Inc.) at a dose of 1.2mg SQ daily. Within 2 weeks
`she noticed hives around the injection site which became diffuse, only resolv-
`ing after discontinuing the growth hormone. Skin testing was performed (both
`prick and intradermal) to the diluent alone, 1:100 dilution of the Nutropin, and
`concentrate Nutropin. Since no standardized extracts are available for skin
`testing, 3 control subjects were also tested and were negative. Prick test to
`latex was also done to rule out any reaction to the vial or syringe used to deliver
`the nutropin and was negative. Results The patient was negative to both prick
`and ID testing to Nutropin. She was then challenged with a test dose of 1/10
`of the full dose given SQ in the ICU. Within minutes, she developed diffuse
`urticaria.
`Because of her nee
`Nutropin and history of developing urticaria, she was admitted for desensiti-
`zation. She was desensitized by using successively increasing amounts of
`Nutropin until our top dose of 1.2mg was reached. We started with 1:1000000
`dilution of 1.2mg Nutropin, diluted in 20cc of saline and given as an IV infu-
`sion over 20 minutes. This was followed by 1:100000, 1:10000, 1:1000, 1:100,
`1:10 dilutions, and the full 1.2mg of Nutropin given IV. The patient was then
`given 1.2mg SQ 24 hours later, and was discharged uneventfully. Since then,
`she has remained on daily Nutropin injections for 7 months without any fur-
`ther reactions. Conclusions Although extremely rare, a hypersensitivity reac-
`tion to growth hormone may occur. Because of the lack of standardized reagents
`for skin testing, a negative skin test does not necessarily rule out a hypersen-
`sitivity reaction. Our protocol for intravenous desensitization to growth hor-
`mone seems to be safe and effective.
`
`P156
`SUCCESSFUL DESENSITIZATION TO GLATIRAMER ACETATE
`(COPAXONE) IN TWO PATIENTS WITH MULTIPLE SCLERO-
`SIS.
`H.T. Katz,* D.M. Lang, S.R. Inamdar, F.H. Hsieh, Cleveland, OH.
`Introduction: Copaxone (Cpxn) is a polymer consisting of four amino
`acids, mannitol and sterile water. It is indicated for the reduction of relapses
`in relapsing-remitting multiple sclerosis (MS). We report two cases of suc-
`cessful desensitization to Cpxn. Case 1: A 31 year-old female with MS devel-
`oped urticaria on both arms five hours after her first dose of Cpxn. She denied
`associated respiratory, cardiovascular, or gastrointestinal symptoms. Despite
`her skin lesions, she continued daily Cpxn use. These lesions did not improve
`with antihistamine therapy (diphenhydramine and cetirizine) and became more
`extensive, involving her legs and trunk. She decided to discontinue Cpxn after
`10 days because of persistent urticaria, which resolved within 2 days. She
`was evaluated one week after discontinuing Cpxn. Examination revealed no
`skin lesions. Skin testing was not performed due to dermatographism. She
`underwent subcutaneous desensitization, which was tolerated without adverse
`reaction as shown in table I. She has tolerated daily Cpxn for more than 10
`months. Case 2: A 43 year-old male with MS developed generalized pruritis
`
`VOLUME 92, JANUARY, 2004
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`167
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`Page 2 of 2
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`YEDA EXHIBIT NO. 2091
`MYLAN PHARM. v YEDA
`IPR2015-00644