Letter to the Editor: Gastroenterology: Inflammatory Bowel Disease
Samalik, Joann MD*; Adler, Jeremy MD, MSc*,†; Singer, Andrew A. M. MD*
From the *Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, MI
†Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI.
Received August 8, 2022; accepted November 14, 2022.
The authors report no conflicts of interest.
Address correspondence and reprints requests to Andrew A. M. Singer, MD, 1500 E. Medical Center Drive, MPB 5251, Ann Arbor, MI 48109 (e-mail: [email protected]).
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
We would like to thank Dr. Sunny et al (1) for their important contribution on hypersensitivity reactions to intravenous ustekinumab. They report 6 patients who had infusion reactions to intravenous dosing of ustekinumab, 4 of whom subsequently tolerated subcutaneous dosing. We report an additional 4 cases of these reactions (Table 1). Our patients experienced similar hypersensitivity symptoms. After treatment of hypersensitivity reactions, all 4 successfully completed their intravenous infusions without further reaction, and each tolerated subsequent subcutaneous dosing of ustekinumab. Our patients did not undergo testing for ethylenediaminetetraacetic acid (EDTA) sensitivity.
| Patient |
A |
B |
C |
D |
| Onset of reaction (min) |
3 |
5 |
1 |
1 |
| Rash/flushing |
X |
X |
X |
X |
| Shortness of breath |
X |
X |
|
|
| Oxygen desaturation |
X |
X |
|
|
| Nausea |
|
X |
X |
|
| Dizziness |
|
|
X |
|
| Cough |
X |
X |
X |
|
| Scratchy throat |
|
|
X |
|
| Duration of SQ UST use |
2 doses |
~12 mo |
May 2021–present |
April 2022–present |
| Reason for discontinuation |
Lack of response/low drug level |
Found XIAP deletion, underwent bone marrow transplant |
- |
- |
SQ = subcutaneous; UST = ustekinumab.
It is crucial that providers are aware that continued treatment with ustekinumab may be an option despite initial hypersensitivity reaction to the intravenous infusion. Most pediatric patients starting ustekinumab have failed or had adverse events with more standard therapies and have limited remaining therapeutic options. Knowing that patients who have a reaction to the intravenous induction dose may still tolerate subcutaneous ustekinumab may prevent hasty discontinuation and allow more patients to continue ustekinumab for inflammatory bowel disease treatment. We emphasize the importance of the authors’ initial contribution and provide further evidence by documenting 4 additional pediatric patients who tolerated consequent subcutaneous ustekinumab dosing. Additional research is needed to understand the physiology of these reactions, determine proactively which patients are at risk, and differentiate who can continue the medication safely.
The chart review of these patients was approved by the University of Michigan IRB.
REFERENCES
1. Sunny J, Fonseca AG, Crim AM, et al. Hypersensitivity reaction to ustekinumab in pediatric and young adult inflammatory bowel disease patients: a case series. JPGN Reports. 2022;3:e205.
