- Email: [email protected]
Successful intrathecal administration of methotrexate following a prior adverse reaction to intravenous methotrexate
Abstracts S311
1144
Successful Intrathecal Administration of Methotrexate Following a Prior Adverse Reaction to Intravenous Methotrexate
D. R. McDonald, M. J. Dorsey, A. Dioun; Immunology, Children’s Hospital, Boston, Boston, MA. RATIONALE: Adverse reactions to methotrexate are increasingly common and represent potential barriers to treatment options for oncologic diseases. There are no reports in the literature addressing intrathecal administration of methotrexate following adverse reactions to intravenous methotrexate. METHODS: A 6 year old, male patient developed hives and pruritus after intravenous infusion of 2 gm of methotrexate for Acute Lymphoblastic Leukemia as well as concomitant morphine infusion. Skin testing to methotrexate (skin prick 1 mg/ml, 10 mg/ml, intradermal 0.1 mg/ml, 1 mg/ml, 10 mg/ml) was negative. The patient required treatment with intrathecal methotrexate. Since the safety of intrathecal administration of methotrexate following desensitization is unknown, further assessment of the patient’s sensitivity to methotrexate was determined by graded challenge (10% dose followed by 90% dose) in the Intensive Care Unit. Following two successful intravenous infusions, methotrexate was infused intrathecally, first with steroid pretreatment, then without steroid pretreatment. RESULTS: The patient tolerated the graded challenge to methotrexate and subsequent full dose infusions of methotrexate without complications, indicating no hypersensitivity to methotrexate. Methotrexate was subsequently administered intrathecally with steroid pretreatment followed by subsequent intrathecal infusions without steroid pretreatment. No adverse events occurred. CONCLUSIONS: A combination of history, skin testing, and graded challenge may be utilized to elucidate the nature of adverse reactions to methotrexate. This information may help determinine the safety of future treatment options with methotrexate, including intrathecal administration. Funding: Self-funded
TUESDAY
J ALLERGY CLIN IMMUNOL VOLUME 113, NUMBER 2
1144
Successful Intrathecal Administration of Methotrexate Following a Prior Adverse Reaction to Intravenous Methotrexate
D. R. McDonald, M. J. Dorsey, A. Dioun; Immunology, Children’s Hospital, Boston, Boston, MA. RATIONALE: Adverse reactions to methotrexate are increasingly common and represent potential barriers to treatment options for oncologic diseases. There are no reports in the literature addressing intrathecal administration of methotrexate following adverse reactions to intravenous methotrexate. METHODS: A 6 year old, male patient developed hives and pruritus after intravenous infusion of 2 gm of methotrexate for Acute Lymphoblastic Leukemia as well as concomitant morphine infusion. Skin testing to methotrexate (skin prick 1 mg/ml, 10 mg/ml, intradermal 0.1 mg/ml, 1 mg/ml, 10 mg/ml) was negative. The patient required treatment with intrathecal methotrexate. Since the safety of intrathecal administration of methotrexate following desensitization is unknown, further assessment of the patient’s sensitivity to methotrexate was determined by graded challenge (10% dose followed by 90% dose) in the Intensive Care Unit. Following two successful intravenous infusions, methotrexate was infused intrathecally, first with steroid pretreatment, then without steroid pretreatment. RESULTS: The patient tolerated the graded challenge to methotrexate and subsequent full dose infusions of methotrexate without complications, indicating no hypersensitivity to methotrexate. Methotrexate was subsequently administered intrathecally with steroid pretreatment followed by subsequent intrathecal infusions without steroid pretreatment. No adverse events occurred. CONCLUSIONS: A combination of history, skin testing, and graded challenge may be utilized to elucidate the nature of adverse reactions to methotrexate. This information may help determinine the safety of future treatment options with methotrexate, including intrathecal administration. Funding: Self-funded
TUESDAY
J ALLERGY CLIN IMMUNOL VOLUME 113, NUMBER 2