Successful desensitisation to deferasirox in a paediatric thalassaemia patient: A case report.

A case report of the successful desensitisation of a four year old paediatric patient with beta thalassaemia major to deferasirox following a serious adverse skin reaction. A four year old girl with beta thalassaemia major was commenced on deferasirox 125 mg daily in May 2012. After one week she developed a widespread, erythermatous macular rash. Erythema multiforme was diagnosed. Deferasirox was ceased and the rash resolved over coming weeks. She was re-challenged the following month with deferasirox and developed angioedema of the lips and a mouth ulcer one day after re-commencement. A literature search was undertaken to identify deferasirox desensitisation case reports. One abstract was located, reporting three cases of successful deferasirox desensitisation in adults. To our knowledge there are no reported cases or protocols of deferasirox desensitisation in children in the literature. Aside from case reports, data regarding other medical desensitisation protocols in children is also limited. Immunology, thalassaemia and pharmacy departments formulated a paediatric deferasirox desensitisation schedule based on paediatric antibiotic desensitisation protocols in a recent review and the hospital adult deferasirox desensitisation protocol. The starting dose was the same as the adult protocol with the doses being increased at a slower rate and smaller increments, so that the full paediatric dose could be reached in the same time frame as the adult protocol. The child was administered deferasirox daily, with dosage approximately doubling at each dose increase over 25 days starting at 1.25 mg until target dose was reached. Each dose increase was given under close observation in hospital. The patient tolerated desensitisation and reached target dose without complications. She is successfully continuing oral deferasirox treatment. This case is the first to our knowledge of a paediatric deferasirox desensitisation and shows the potential for more use of this desensitisati