Methods:Cases of hypersensitivity reaction to rabbit ATG were retrieved from a database of individual case safety reports in Seoul National University Hospital from 2010 to 2015. Clinical characteristics of hypersensitivity reactions were analyzed according to involved organ system and severity was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.
Results:Among 82 patients, male was 36 (44.4%). The average age was 21.5 ± 19.6. High fever (100%) was the most frequent symptom followed by chill (95%) and cutaneous symptoms (65%) such as itching sense, flushing, urticaria and rash. The following majority of symptoms is gastrointestinal symptoms such as nausea, vomiting, abdominal pain and diarrhea. The mean severity was CTCAE grade 2.7 ± 0.9. Although all patients were premedicated with anti-histamine and steroid, 51.2% had grade 3 or 4 reactions including cases presented with profound hypotension (36.0%). After the development of ATG hypersensitivity, most patients were able to continue the following ATG infusion by increasing the doses of anti-histamine and steroid (76.5%) or by slowing infusion rate (13.6%), and desensitization (7.4%).
Conclusion: ATG hypersensitivity reactions presented as a severe form in half of cases reported. However, most patients with ATG hypersensitivity were able to continue ATG infusion by increasing premedication or modifying infusion protocol.