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Management of hypersensitivity reactions to anti‐D immunoglobulin preparations
Author(s) -
Rutkowski K.,
Nasser S. M.
Publication year - 2014
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.12494
Subject(s) - medicine , anaphylaxis , pregnancy , drug allergy , hypersensitivity reaction , drug , delayed hypersensitivity , fetus , immunology , allergy , incidence (geometry) , antibody , rh isoimmunization , immunoglobulin e , obstetrics , antigen , pharmacology , genetics , physics , optics , biology
RhD immunoglobulin G (anti‐D) administered to pregnant Rh(−) women prevents Rh isoimmunization. Its use has significantly reduced the incidence of haemolytic disease of the foetus and newborn previously responsible for one death in every 2200 births. In pregnancy, acute drug‐induced hypersensitivity reactions including anaphylaxis can have serious deleterious effects on the mother and foetus/neonate. Women can be erroneously labelled as drug allergic as the investigation of hypersensitivity reactions in pregnancy is complex and drug challenges are usually contraindicated. We present three cases of suspected anti‐D hypersensitivity clinically presenting as anaphylaxis and delayed transfusion‐related reaction. We also propose a new algorithm for the investigations of such reaction. It relies on detailed history, cautious interpretation of skin tests, foetal Rh genotyping from maternal blood and, in some cases, anti‐D challenges. This is not to deprive women of anti‐D which might put their future pregnancies at risk.