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Practitioner's Corner

J Investig Allergol Clin Immunol 2019; Vol. 29(5): 378-398

© 2019 Esmon Publicidad

as premedication in an attempt to reintroduce the drug with

tolerance. A provocation test was programmed for 2 days to

achieve a total dose of 1000 mg of abiraterone. The protocol

on the first day comprised 50 mg, 150 mg, and 300 mg, with a

1-hour interval between doses and 2 hours of observation after

the last dose (cumulative dose, 500 mg). Ten hours after the

challenge was completed, the patient developed a pruriginous

micropapular rash on the thorax, affecting the groins and the

axillas (Supplementary Material, Photo). Once the Urology

Department confirmed that abiraterone was the first‐choice

agent for this patient, we developed a desensitization protocol

(Table) in collaboration with the Pharmacy Department.

Doses were prepared by weighing the corresponding amount

of powder (10 mg, 30 mg, and 125 mg) and filling empty

gelatine capsules. Dextrin maltose was used as the excipient.

The desensitization protocol was stepped up every 3 days

at the hospital, starting with the 10‐mg dose; the patient

maintained the maximum tolerated dose at home (Table). We

decided to premedicate the patient with ebastine 20 mg/24 h

and prednisone 15 mg/12 h. Once the total dose was reached,

ebastine was stopped, and prednisone was stepped down,

continuing with 10 mg/12 h during the following 2 days

and maintaining 5 mg/12 h, as per the summary of product

characteristics of abiraterone. The patient did not experience

any problems or adverse events during the protocol, which

was fully tolerated. Allergic reactions to anticancer drugs are

a growing problem in allergology clinics, and desensitization

protocols are useful when the drug involved is a first‐choice

option [3]. Rapid desensitization in IgE‐mediated reactions

has well‐defined pathophysiological mechanisms, and

while the procedure is risky, it has proven to be safe and

efficacious [4]. In the case of late reactions (ie, more than

1 hour after administration), which are similar to those in

the present case and are also frequently managed with rapid

desensitization [5], there is no consensus on the ideal protocol,

Safe and Successful Protocol for Desensitization to


Núñez-Acevedo B


, Rubio-Pérez M


, Padial-Vilchez A


, de la

Morena-Gallego JM


, Barro-Ordovás JP


, Reche-Frutos M



Valbuena-Garrido T



Allergy Department, Hospital Universitario Infanta Sofía, San

Sebastián de los Reyes, Madrid, Spain


Urology Department, Hospital Universitario Infanta Sofía, San

Sebastián de los Reyes, Madrid, Spain


Pharmacy Department, Hospital Universitario Infanta Sofía,

San Sebastián de los Reyes, Madrid, Spain

J Investig Allergol Clin Immunol 2019; Vol. 29(5): 386-387

doi: 10.18176/jiaci.0408

Key words:

Abiraterone. Desensitization. Drug Allergy.

Palabras clave:

Abiraterona. Desensibilización.Alergia a medicamentos.

Abiraterone acetate is used for the treatment of castration‐

resistant metastatic prostate cancer. It acts as a selective

inhibitor of the enzyme 17 α‐hydroxylase/C17,20‐lyase

(CYP17). Expression of this enzyme is necessary for the

synthesis of androgens in the testicles, adrenal glands, and

prostate tumor tissue; therefore, inhibition leads to reduced

production of androgens. Given that inhibition of CYP17 also

leads to increased production of mineralocorticoids by the

adrenal glands, abiraterone should be taken with prednisone.

While abiraterone is generally well tolerated, the summary of

product characteristics and various studies list hypertension,

hypokalemia, and hepatotoxicity as common adverse

effects [1,2]. We present the case of a 63‐year‐old man with a

personal history of hypothyroidism and sleep apnea hypopnea

syndrome treated with continuous positive airway pressure

who was diagnosed with prostate cancer (Gleason 4+5) and

bone metastasis (T10 and left iliac spine). The patient had an

initial clinical response to treatment with enzalutamide. As

he remained asymptomatic, his urologist decided to maintain

hormone treatment instead of taxane-based therapy, starting

with abiraterone 1000 mg every 24 hours, together with

prednisone 5 mg every 12 hours. After 4 days of treatment,

the patient developed a fairly symmetrically distributed

micropapular rash on the trunk (mainly the abdomen), both

groins, and the root of the upper limbs. He also complained

of axillary pruritus, although no lesions were visible at this

level. There was no fever or mucous membrane involvement.

He was evaluated in the urology department, where treatment

was suspended. The rash resolved 4 days later, with minimum

fine desquamation and no residual lesions.

We carried out an allergological work‐up starting with skin

prick tests at 200 mg/mL, although the result was negative.

We decided not to perform patch tests, because standardized

options with abiraterone are lacking. Even though the rash was

indicative of a drug reaction, the fact that it was not severe

led us to assess oral tolerance after adding ebastine 20 mg


Desensitization Protocol

Day 1

Doses administered at hospital with

10 mg

30-minute intervals

20 mg

40 mg

60 mg

125 mg

Day 2 and Day 3

Dose at home

125 mg

Day 4

Dose at hospital

250 mg

Day 5 and Day 6

Doses at home

250 mg

Day 7

Dose at hospital

500 mg

Day 8 and 9

Doses at home

500 mg

Day 10

Dose at hospital

1000 mg