Desensitization of patients with hypersensitivity to infliximab

Background: Infliximab treatment is highly effective in Crohn's disease and exhibits an acceptable level of long-term safety, though hypersensitivity can develop, precluding further medication.

Aim: To prevent an early infusion reaction in patients with previous history of hypersensitivity to infliximab.

Case reports: Between April 2003 and January 2005 a total of 82 infliximab infusion treatments were administered to 28 patients. Infusion reactions developed in 2 patients. In a 24-year-old female who had received 5 infliximab infusions since April 2004, the efficacy of infliximab was observed to steadily decrease. The second patient was a 28-year-old female patient, who had been treated with 3 infusions of infliximab since April 2003. Her hypersensitivity reaction developed after the fourth infusion.

Methods: To restore the safety and efficacy of infliximab, a desensitization protocol was used (1). The total dose of 5mg/kg infliximab was divided into 11 increments according to a dose escalation schedule. Each increment was administered to the patient within 15 minutes. There were no intervals between the infusions.

Results: The infusion increments were well tolerated. No infusion reaction was observed subsequently on retreatment with infliximab, and both patients reported a significant increase in their general state of health.