Antithymocyte globulin hypersensitivity in bone marrow failure patients
L. Bielory, R. Wright, A. W. Nienhuis, N. S. Young and M. A. Kaliner
Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103-2757.
We evaluated the predictive value of immediate epicutaneous (prick) skin
testing in 36 patients receiving a heterologous protein of equine origin,
antithymocyte globulin (ATG), for bone marrow failure. Three of the 36
patients had positive epicutaneous test results. Two of these three
received ATG treatment; one died of anaphylaxis while the other was
desensitized successfully. Intradermal skin tests revealed positive
wheal-flare reactions to progressively increasing dilutions of ATG in 96%
of patients tested. None of these patients suffered any anaphylactic
symptoms during treatment. Nine patients who had received ATG were
evaluated subsequently for the possible development of immediate
epicutaneous reactions three to 12 months after treatment; one of the nine
patients developed a positive epicutaneous skin test reaction. We recommend
that all patients who are to be treated or re-treated with heterologous
antisera should be tested using the epicutaneous technique and that
patients with positive reactions should be desensitized.
