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Cyclosporine is one of the main drugs used for the prophylaxis of graft versus host disease in bone marrow transplanted patients. Hypersensitivity reaction to intravenous cyclosporine is rare and might be due to its vehicle polyoxyethylated castor oil, Cremophor EL. The exact mechanism is unknown, but IgE and IgG antibodies, complement, and histamine release have been considered to play a role in the development of this reaction. Here, we describe a case of anaphylaxis to intravenous cyclosporine, which was developed in a 19-year-old Iranian female with acute myeloid leukemia who underwent allogeneic bone marrow transplantation from her sister. The corn oil-based soft gelatin capsule (Sandimmune ® ) was substituted with no reaction. Our observation along with the previous reports confirms the role of Cremophor EL in hypersensitivity reaction to cyclosporine, according to which, modifying the formulation of the intravenous (IV) form could be the solution for this problem., Competing Interests: There are no conflicts of interest.

Objective: To report the occurrence and management of pulmonary compromise, marked leukocytosis, and eosinophilia in a patient receiving P-in-oil after IVF and embryo transfer., Design: Case report.A tertiary referral reproductive medicine unit., Patient(s): A 29-year-old patient receiving P-in-oil supplementation after IVF embryo transfer., Intervention(s): Extensive diagnostic testing and surveillance for hypersensitivity to P in sesame oil; development of an alternative oil-based P-in-oil suspension., Main Outcome Measure(s): Tolerance of alternative P vehicle; clinical pregnancy., Result(s): The patient tolerated an alternative P oil vehicle and successfully achieved a clinical pregnancy after frozen embryo transfer., Conclusion(s): Although rare, hypersensitivity reactions may occur in patients receiving P-in-oil supplementation after IVF embryo transfer. Testing for tolerance and subsequent use of alternative P vehicles may be an effective strategy in managing patients with sensitivity to P-in-oil.

Background: Cancer patients treated with the anticancer drug, paclitaxel (Taxol) often experience mild to severe hypersensitivity reactions. It is not known how these reactions are induced and whether the inducer is paclitaxel or its vehicle (i.e., Cremophor EL in 50% ethanol). Molecules present in Cremophor EL are similar in structure to certain nonionic block copolymers that activate complement proteins (i.e., proteins involved in various immune processes). To explore the role of complement in the observed hypersensitivity reactions, we studied the effects of paclitaxel and Cremophor EL plus ethanol on human complement in vitro., Methods: Serum specimens from healthy individuals and cancer patients were incubated with paclitaxel or with relevant control compounds (Cremophor EL with ethanol, ethanol only, docetaxel, and cyclosporine), and markers of complement activation (SC5b-9 and Bb) were measured by enzyme-linked immunosorbent assay. Similar incubations were performed in the presence of inhibitors of complement activation (i.e., EGTA/Mg2+ and soluble complement receptor type 1 [sCR1])., Results: Paclitaxel in Cremophor EL plus ethanol caused increased formation of SC5b-9 in serum specimens from 10 of 10 healthy control subjects and from five of 10 cancer patients. Experiments with one or more individual sera indicated the above effect was due to Cremophor EL plus ethanol, that increased formation of Bb also occurred, that the drug-induced rise in SC5b-9 was inhibited by sCR1, and that EGTA/Mg2+ partially inhibited SC5b-9 formation and stimulated Bb formation., Implication: The role of complement activation in hypersensitivity reactions associated with administration of paclitaxel in Cremophor EL plus ethanol should be studied in vivo.

Topically applied drugs which can cause contact dermatitis are numerous and diverse. The ingredients for vehicles, base components and additives, are as frequently the cause of drug eruptions as active ingredients. Patients with chronic leg ulcers are particularly exposed to the risk of developing allergic contact dermatitis. The diagnosis is based on the analysis of causative association between the localisation (often limited) of the lesions, the moment of their appearance and the application of a drug into the skin. Use tests and/or patch-tests are tools for determining the diagnosis. The exact knowledge of the offending ingredient, of its potential sources and the possibility of cross-allergy are essential in order to prevent recurrence. Indeed, the causative treatment of drug contact dermatitis is based on the prescription and effective application of strict avoidance of the causative allergen, a procedure which necessitates special informative measures to both the patient and to his medical care environment.

The drug delivery systems which contain not only the active principle but also many auxiliary substances are often underestimated with respect to their desired and undesired effects. Due to their composition, their purity, their physical, chemical or biopharmaceutical properties, the pharmaceutical system may be taken into consideration at each pharmacodynamic and clinical evaluation. The importance of some pharmaceutical properties on nondesired effects are shown with the examples of insufficient degradation and drug release, too quick drug alteration, inhomogeneous distribution and the role of badly selected excipients as well as the negative influence of food on drug plasma levels.

Patch testing with Iodine/potassium-iodide (3%) and commercialized povidone (PVP)-iodine preparations (Betaisodona-ointment and solution, Polyvidon-Jod-ointment "Braun", Braunol-solution "Braun", Traumasept-ointment, and Traumasept solution--not marketed--, were carried out in 104 patients of the Department of Dermatology of the Municipal Hospital Kassel. In addition, the according ointment and solution-bases were tested. 22 tests were patients with ulcera crurum, 82 patients with infectious skin diseases or skin tumors. 35 out of the 104 patients showed positive reactions to iodine/potassium-iodide. Hyperreactivity to one or more PVP-iodine-ointments was found in 12 patients, to one or more PVP-iodine solutions in 29 patients. If there was no positive reaction to iodine/potassium-iodide, PVP-iodine ointments were always tolerated, while PVP-iodine-solutions produced positive reactions in 9 cases even then. Our results show that allergic skin reactions must be expected in 2-9% of all patients using PVP-iodine ointments, and in 12-20% of all patients using PVP-iodine-solutions. If iodine-allergy is known the rate of positive reactions to PVP-iodine ointments is 6-25% to the solutions 34-60%.