@article{7adae033f89440488fac73f82ae54796,
title = "Vitreous Injections of Pegaptanib Sodium Triggering Allergic Reactions",
abstract = "Purpose: To report two cases of systemic allergic response associated with vitreous administration of pegaptanib sodium. Design: Observational case report. Methods: Two patients were treated for systemic allergic reactions associated with the administration of pegaptanib sodium. Results: One patient developed a delayed and prolonged anaphylactoid reaction following administration of his first dose of intraocular pegaptanib sodium. The second patient received four injections of pegaptanib over the course of six months. He developed mild lip swelling and prolonged urticarial rash following the first injection, which subsided when pegaptanib was suspended. Conclusions: Severe hypersensitivity reactions may occur in association with vitreous administration of pegaptanib sodium and may be associated with prolonged urticaria and angioedema. Elderly individuals with comorbidities are at higher risk for fatality from severe hypersensitivity reactions in the ambulatory setting. Physicians administering pegaptanib sodium should review emergency response and airway procedures.",
author = "Steffensmeier, {Andrew C.G.} and Azar, {Antoine E.} and Fuller, {Jeffrey J.} and Muller, {Barbara A.} and Russell, {Stephen R.}",
note = "Funding Information: A 87-year-old man developed generalized urticaria approximately 12 hours after initial administration of pegaptanib sodium for occult CNV. Prolonged urticaria (lasting days) was observed by the patient with associated transient (hours) lip angioedema. The symptoms occurred following each of four injections. The patient reported these symptoms after the fourth administration. The rash was observed six weeks following the fourth injection ( No other changes in his medical regimen or environmental factors occurred during this time to explain the symptoms. Bevacizumab was substituted for the subsequent injection. Symptoms resolved within one week without additional treatment. Figure ). Hypersensitivity reactions occurred following vitreous pegaptanib administration and were associated with prolonged allergic manifestations in two cases. The temporal relationship of these patients{\textquoteright} symptoms to the drug injection strongly suggests an adverse reaction to pegaptanib. The other medications are unlikely, as both patients received these without consequence. Graded skin testing to all these agents was negative as was in vitro testing for latex specific IgE. We hypothesize that pegaptanib was caused by an anaphylactoid reaction rather than an anaphylactic reaction, given that an IgE-mediated anaphylactic reaction would require prior exposure to the offending agent, and that skin testing was negative. The angioedema in the first patient, which persisted for more than 36 hours, could reflect a continuous stimulus provided by slow absorption of pegaptanib from the vitreous compartment to the systemic circulation or could have been due to a subconjunctival depot effect. Pharmacokinetic studies involving pegaptanib have demonstrated serum levels ranging from 4.0 to 278 ng/ml (one hour and 24 hours after dosing, respectively), 3 although measurable antigen serum levels may not be necessary to induce anaphylactoid reaction. These reactions could conceivably be related to the polyethylene glycol (PEG) moieties of pegaptanib. PEG containing products have been associated with cutaneous contact sensitivity and urticarial reaction. 4,5 Angioedema and anaphylactoid reactions have been reported with gastrointestinal exposure to polyethylene glycol electrolyte lavage solution (Golytely). 6,7 This study was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York. Dr Russell received support from the following advisory boards: Alcon Laboratories, Pfizer, Inc, and Novartis and Grant support from Alcon Laboratories; stock Alcon Laboratories, and Pfizer, Inc. Involved in design and conduct of study (A.C.G.S., A.E.A., J.J.F., B.A.M., S.R.R.); involved in analysis (A.C.G.S., J.J.F., A.E.A.); involved in interpretation of data (S.R.R., B.A.M.); involved in preparation of manuscript (A.C.G.S., A.E.A., S.R.R.), and involved in review or approval of manuscript (J.J.F., B.A.M.). ",
year = "2007",
month = mar,
doi = "10.1016/j.ajo.2006.10.007",
language = "English (US)",
volume = "143",
pages = "512--513",
journal = "American journal of ophthalmology",
issn = "0002-9394",
publisher = "Elsevier USA",
number = "3",
}