leuprolide and Anaphylaxis

Gonadotropin-releasing hormone analogues are used in the treatment of prostate cancer, breast cancer, endometriosis, and uterine leiomyomas in adults and often in the treatment of precocious puberty in children. Many adverse effects have been reported for gonadotropin-releasing hormone analogues, but anaphylaxis is rarely reported as an adverse effect. Frequent cross-reactions, particularly during childhood, and diversity of the time of onset of anaphylactic manifestations complicate the diagnosis. A patient who exhibited anaphylactic allergic reactions to two different agents used in the treatment of central precocious puberty presented here because the case has an atypical course and is the first in the literature.

Topics: Adult; Anaphylaxis; Antineoplastic Agents, Hormonal; Child; Female; Humans; Leuprolide; Prognosis; Puberty, Precocious; Triptorelin Pamoate

Gonadotropin-releasing hormone analog depots have been widely used for a variety of diseases including prostate cancer, breast cancer, endometriosis, uterine leiomyomas, and central precocious puberty. Most of the side/adverse effects of gonadotropin-releasing hormone analog depots, such as leuprorelin acetate depot, are related to hypotestosteronism in males. Anaphylaxis to gonadotropin-releasing hormone analog depot is extremely rare. We present the first case report of a Japanese man who developed anaphylaxis to leuprorelin acetate depot during the treatment of metastatic prostate cancer and recovered successfully by conservative treatment. A drug-lymphocyte stimulation test showed that not only leuprorelin acetate itself, but also its vehicle polylactic and glycolic acids, might be responsible for the anaphylaxis to leuprorelin acetate depot. Because anaphylaxis can be lethal, the present case suggests that one should bear in mind the possibility of anaphylaxis in all patients who receive gonadotropin-releasing hormone analog depot and monitor such patients carefully.

Topics: Aged; Anaphylaxis; Antineoplastic Agents, Hormonal; Drug Eruptions; Fatal Outcome; Humans; Immunosuppressive Agents; Leuprolide; Male; Prostatic Neoplasms

Anaphylactic reactions to gonadotropin-releasing hormone (GnRH) agonists are exceedingly rare, but if they occur, they can be life threatening. This case describes a 33-year-old patient with endometriosis who developed an acute allergic reaction on leuprolide (Lucrin) administration. Although skin tests with the replacement goserelin (Zoladex) were negative, usage of this medication resulted in a similar allergic reaction. This is the first case report that shows that, in case of a proven allergy to one GnRH agonist, a switch to another GnRH agonist should not be made even if allergy tests are negative for this medication.

Topics: Adult; Anaphylaxis; Anti-Allergic Agents; Clemastine; Diagnosis, Differential; Endometriosis; Female; Gonadotropin-Releasing Hormone; Goserelin; Histamine H1 Antagonists; Humans; Leuprolide

Two adult female elf owls (Micrathene whitneyi) were treated with leuprolide acetate depot injections to prevent egg laying. The birds were treated for several years without complications. Several years into the treatment regimen, both birds died immediately after receiving an injection of leuprolide acetate. Remaining drug was analyzed, revealing 95.7% potency. We suspect that either an immediate Type 1 hypersensitivity reaction occurred or a contaminant was present, resulting in the fatalities of these elf owls. No reports of anaphylaxis to leuprolide acetate in birds were identified in the literature. Clinicians should be aware of the possibility of anaphylaxis when administering this medication to avian patients.

Topics: Anaphylaxis; Animals; Delayed-Action Preparations; Fatal Outcome; Female; Fertility Agents, Female; Leuprolide; Struthioniformes

A 66-year-old man with clinically localized prostate cancer had elected brachytherapy as the primary management of his disease. During induction of neoadjuvant androgen deprivation for purposes of cytoreduction, the patient experienced anaphylaxis immediately after his first injection of a leuprolide acetate depot. He required emergent intubation and extended hospitalization. Anaphylactic reactions to leuprolide acetate depots have been described as exceedingly rare. To our knowledge, we report the first case of an anaphylactic reaction to a leuprolide acetate depot injection in an American man undergoing treatment for prostate cancer.

Topics: Aged; Anaphylaxis; Antineoplastic Agents, Hormonal; Brachytherapy; Humans; Injections; Leuprolide; Male; Prostatic Neoplasms

An 8-year-old girl with idiopathic central precocious puberty experienced multiple episodes of anaphylaxis after receiving a goserelin acetate implant. She was hospitalized and treated with epinephrine, antihistamine, and corticosteroids. The goserelin implant was surgically excised; however, anaphylactic symptoms continued for 4 days after excision. Less severe systemic symptoms recurred 6 weeks after removal; these were possibly due to leakage of the depot drug into subcutaneous tissues. It was noted that 3 years earlier, the patient had developed a similar, milder systemic allergic reaction to leuprolide acetate that required treatment with oral prednisone and antihistamines. Intradermal testing yielded positive results for leuprolide. Gonadotropin-releasing hormone (GnRH) analogs, including leuprolide acetate and goserelin acetate, are commonly prescribed for patients with prostatic carcinoma, endometriosis, and precocious puberty. A literature review identified a single case report of a systemic hypersensitivity reaction involving goserelin acetate and several reports of systemic hypersensitivity reactions associated with leuprolide acetate. We found no reports of systemic reactions to GnRH analogs in pediatric patients. Clinicians should be aware of the potential association of GnRH analogs with systemic reactions. They should also recognize that recurrent anaphylaxis may occur due to the long half-life of these therapeutic agents in tissue.

Topics: Anaphylaxis; Child; Child, Preschool; Drug Hypersensitivity; Drug Implants; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Goserelin; Humans; Leuprolide; Luteinizing Hormone; Puberty, Precocious

Topics: Aged; Anaphylaxis; Drug Hypersensitivity; Humans; Leuprolide; Male

Experience with depot forms of hormonal preparations suggests that severe adverse reactions are infrequent and immediate hypersensitivity reactions are rare. We report a case of recurrent anaphylaxis to a depot form of GnRH analogue requiring both acute and chronic management.

Topics: Adult; Anaphylaxis; Delayed-Action Preparations; Emergencies; Endometriosis; Female; Humans; Leuprolide; Skin Tests; Time Factors; Uterine Neoplasms