Drug fever-an immune-mediated delayed type hypersensitivity reaction to Vinca alkaloids in pediatric oncology patients, possibly mediated by cysteinyl leukotrienes.

Autor:	Kidon MI; Pediatric Allergy Unit, Edmond and Lilly Safra Children's Hospital Safra, Sheba Medical Center, Ramat Gan, Israel.; Allergy and Clinical Immunology Unit, Sheba Medical Center, Ramat Gan, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Haj Yahia S; Pediatric Allergy Unit, Edmond and Lilly Safra Children's Hospital Safra, Sheba Medical Center, Ramat Gan, Israel.; Allergy and Clinical Immunology Unit, Sheba Medical Center, Ramat Gan, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Abebe-Campino G; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Hemato-Oncology, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel., Agmon-Levin N; Pediatric Allergy Unit, Edmond and Lilly Safra Children's Hospital Safra, Sheba Medical Center, Ramat Gan, Israel.; Allergy and Clinical Immunology Unit, Sheba Medical Center, Ramat Gan, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Yelon M; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Hemato-Oncology, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.
Jazyk:	angličtina
Zdroj:	Frontiers in allergy [Front Allergy] 2024 Aug 06; Vol. 5, pp. 1361403. Date of Electronic Publication: 2024 Aug 06 (Print Publication: 2024).
DOI:	10.3389/falgy.2024.1361403
Abstrakt:	Background: Drug hypersensitivity reactions are common in pediatric hemato-oncology patients due to multiple factors including immune compromise and pharmacological complexities. Fever can signify severe delayed-type hypersensitivity reactions such as drug reaction with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS). The etiology of fever as an isolated hypersensitivity reaction to chemotherapeutic agents not fully understood. Here, we report three children with intracranial neoplasms experiencing recurrent febrile reactions following Vinca alkaloid-based chemotherapy, mitigated by cysteinyl leukotriene receptor antagonist therapy. Methods: We present a series of pediatric patients with diverse intracranial neoplasms who developed recurrent fever episodes after multiple courses of Vinca alkaloid-based chemotherapy. Treatment involved prophylactic and post-chemotherapy administration of a cysteinyl leukotriene receptor antagonist to prevent fever episodes and enable completion of chemotherapy regimens without protocol modifications or desensitization. Results: All three patients experienced fever consistent with delayed-type hypersensitivity reactions to Vinca alkaloids. Prophylactic use of the leukotriene antagonist Montelukast successfully prevented fever recurrence, allowing uninterrupted completion of chemotherapy courses. Conclusion: Our findings suggest that Montelukast, a leukotriene antagonist, may be beneficial in managing fever as a delayed-type hypersensitivity reaction to Vinca alkaloids in pediatric patients. Further research is warranted to elucidate the underlying mechanisms and leukotriene pathways involved in drug-induced fever reactions. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2024 Kidon, Haj Yahia, Abebe-Campino, Agmon-Levin and Yelon.)
Databáze:	MEDLINE
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