SUCCESSFUL RAPID LIPOSOMAL AMPHOTERICIN-B DESENSITIZATION IN PEDIATRIC
CASE SERIES AND LITERATURE REVIEW
Abstract
Background: Amphotericin B is the broadest-spectrum polyene
group antifungal agent. In the presence of an infection caused by a
fungal agent resistant to alternative antifungal drugs, desensitization
may be the only option to continue treatment. However, there is
insufficient information and consensus regarding Amphotericin B
desensitization protocols in the pediatric age group.
Objective: In this study, we present our experience with five
cases where successful desensitization protocols were applied with
Liposomal Amphotericin B (AmBisome®; LAMB), along with a review of the
literature on pediatric cases. We also provide a sample desensitization
protocol that we successfully applied. Methods: In this
retrospective study, pediatric patients who continued their treatment
with the successful rapid desensitization protocol conducted at the
Pediatric Allergy and Immunology Clinic of the Ministry of Health Ankara
City Hospital between September 2019 and September 2023 were examined.
In our study, desensitization protocols were applied based on Castell et
al.’s desensitization protocol. Results: Between 2019 and 2023,
five patients aged between 5 and 12 years, including three with
hematologic malignancies, one with tuberculosis meningitis, and one with
chronic granulomatous disease, were referred to us due to the
development of anaphylaxis during their treatment with LAMB. Anaphylaxis
is diagnosed clinically, considering the European Academy of Allergy and
Clinical Immunology (EAACI). A 16-step desensitization protocol was
prepared using LAMB solutions at four different dilutions (0.001 mg/ml,
0.01 mg/ml, 0.1 mg/ml, 1 mg/ml). Each solution consisted of four steps
with a 15-minute infusion for each step. Patients was premedicated with
1 mg/kg/dose methylprednisolone and an antihistamine.
Conclusion: The data we present on the successful application
of a sample protocol to five cases, particularly in a pediatric setting,
is a significant and valuable contribution to the field. This can
provide important insights and potentially serve as a reference for
medical professionals working with similar cases in the future.