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1、0 Freund Publishing House Ltd., London Journal of Pediatric Endocrinology with a higher concentration, 1:100, there was a generalized urticarial reaction (Table 1). No further attempts to reinitiate treat- ment were made. The patients growth velocity gradually dropped and he fell from the 50th to th
2、e 5th percentile of height, prompting a revaluation and desensitization with Humatrope (somatropin, Eli Lilly and Co.)* which uses water with 0.3% m-cresol as a diluent. Intradermal skin tests with 1:1000 dilutions of Nutropin and Humantrope in cresol gave positive wheal and flare reactions larger t
3、han the small flare, without wheal caused by the diluent alone (Table 1). Humatrope in bacteriostatic water gave a similar reaction (data not shown). Three volunteers who underwent intradermal skin testing with a 1:1000 dilution of Humantrope had minor flare reactions without wheals. DESENSITIZATION
4、 We performed intravenous desensitization with Humatrope in its diluent in a hospital setting with anaphylaxis treatment and resuscitation equipment readily available. No premedication was given. The procedure was initiated by starting an i.v. infusion of 5% dextrose 1/3 strength saline by way of a
5、buret. Six stock solutions (0.5 to 0.00005 mg/ml) of Humatrope reconstituted in its diluent were prepared in saline solution. Increasing doses of VOLUME 10, NO. 2, 1997 223 Brought to you by | New York University Bobst Library Technical ServicesBrought to you by | New York University Bobst Library T
6、echnical Services AuthenticatedAuthenticated Download Date | 6/30/15 8:22 PMDownload Date | 6/30/15 8:22 PM224 J. JUNPRASURT ET AL. TABLE 1 Skin tests to recombinant human growth hormone, diluents and histamine Protropin* (somatrem) Nutropin* (somatropin) Humantropc* (somatropin) Prc-dcscnsitization
7、 Post-dcsensitization (24 hrs) Age 5 yrs 9 yrs 9 yrs Growth Hormone + Diluent SPT, undiluted neg neg neg neg IDT, 1:1000 local reaction 6/12* 5/8 0/7 1:100 generalized urticaria Diluent SPT, undiluted neg IDT, 1:1000 0/4 Histamine phosphate SPT 5/20 5/19 4/12 pit-hGH, pituitary human growth hormone;
8、 SPT, skin prick test; IDT, intradermal test. *pit-hGH+methionine (192 amino acids), diluent = bacteriostatic water Vt-hGH (191 amino acids), diluent = bacteriostatic water vpit-hGH (191 amino acids), diluent = 0.3% m-cresol SC = subcutaneous VOLUME 10, NO. 2, 1997 Brought to you by | New York Unive
9、rsity Bobst Library Technical ServicesBrought to you by | New York University Bobst Library Technical Services AuthenticatedAuthenticated Download Date | 6/30/15 8:22 PMDownload Date | 6/30/15 8:22 PM226 J. JUNPRASERT ET AL. the injection site as well as generalized pruritus and urticaria which were
10、 not prevented by pretreatment with diphenhydramine. After desensitization using a series of subcutaneous injections, treatment could be resumed I M . Our patient had generalized urticaria following subcutaneous injection of Protropin and immediate wheal and flare reactions to intradermal skin testi
11、ng of both somatrem and somatropin, persisting 4 years after discontinuing treatment. Our results suggest that intravenous desensitization is a safe and effective alternative to subcutaneous desensitiz- ation in patients who develop growth hormone hypersensitivity. REFERENCES 1. Walker S, Weiss M, T
12、attoni D. Svstcmic reaction to human growth hormone treated with acute desensiti- zation. Pediatrics 1992; 90: 108-109. 2. Borish L. Tamir R, Roscnwasscr L. Intravenous desensitization to beta-lactam antibiotics. J Allergy Clin Immunol 1987; 80: 3 14-319. 3. Petersen K, Khalaf A, Zeisel H. et al. Ig
13、E antibodies to human growth hormone prior to and during treatment. Acta Endocrinol (Cpnh) 1989; 121: 501-504. 4. Flodh H. Present situation worldwide regarding the use and clinical experience of somatonorm (somatrem). Acta Paediatr Scand 1987; Suppl 331: 1-4. 5. Ranke MB, Bierich JR. Clinical exper
14、ience with authentic recombinant somatropin - German collabo- rative study. Acta Paediatr Scand 1987; Suppl 331: 9- 17. 6. Albertson-Wikland K. Clinical trial with authentic recombinant somatropin in Sweden and Finland. Acta Paediatr Scand 1987; Suppl 331:28-34. JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM Brought to you by | New York University Bobst Library Technical ServicesBrought to you by | New York University Bobst Library Technical Services AuthenticatedAuthenticated Download Date | 6/30/15 8:22 PMDownload Date | 6/30/15 8:22 PM
