Background Report of a case of a patient allergic to albumin. In the absence of therapeutic alternatives we proposed an albumin desensitisation protocol.
Purpose To describe how the samples were prepared and the technique administered. To evaluate the effectiveness and safety of the desensitisation protocol for albumin in a patient who developed a hypersensitivity reaction to it.
Material and methods Review of the clinical history of a 72 year-old female diagnosed with liver cirrhosis HCV that had developed over 8 years, portal hypertension, ascites, oesophageal varices and splenomegaly. She was thought to have suffered an allergic reaction to intravenous albumin, based on symptoms after administration including neck rash, facial flushing and chest tightness, after we had eliminated allergy to any of the product excipients.
Alternatives such as administering albumin with premedication (corticosteroids and antihistamines), diuretics and plasma expanders were evaluated without getting the desired result.
After an unsuccessful literature review in which we could not find an albumin desensitisation protocol or a similar case, a protocol was suggested that involved the administration of increasing doses of albumin until a total cumulative dose achieved therapeutic levels.
Results Three albumin preparations were devised: 0.6 grams of albumin diluted in 250 ml of physiological saline to give a concentration of 0.0024 g/ml, a second one with 6 grams in 250 ml for a concentration of 0.024 g/ml and a third preparation with 60 grams of undiluted albumin, which were administered at infusion rates of 5, 10, 20 and 40 ml/h every 15 min.
After four sessions of paracentesis, with subsequent return of 60 grams of albumin infusion as per the desensitisation protocol, the patient did not have a further anaphylactic reaction. The regimen was well tolerated, achieving a final infusion rate of 50 ml/h.
Conclusion The protocol and formulation have proved to be effective and safe for desensitisation to albumin in the clinical case described.
Multidisciplinary collaboration of the professionals involved has enabled treatment with post-paracentesis albumin to be considered a valid therapeutic strategy for patients in the same clinical situation.
References and/or acknowledgements No conflict of interest.
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