PMID- 29977647
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220318
IS  - 2152-6575 (Print)
IS  - 2152-6567 (Electronic)
IS  - 2152-6567 (Linking)
VI  - 9
DP  - 2018 Jan-Dec
TI  - The Eyes Have It: Eyelid Swelling and Rash in a 79-year-old Woman With Macular 
      Degeneration.
PG  - 2152656718763385
LID - 10.1177/2152656718763385 [doi]
LID - 2152656718763385
AB  - INTRODUCTION: A 79-year-old woman with macular degeneration was referred to the 
      Allergy/Immunology clinic for the evaluation of a potential allergy to 
      anti-vascular endothelial growth factor (anti-VEGF) treatments. The patient 
      developed urticaria and eyelid swelling immediately following a retinal injection 
      of aflibercept, which she had previously tolerated. She previously had allergic 
      reactions following ranibizumab and bevacizumab injections. Injections of 
      anti-VEGF treatments were discontinued given concern for allergy with progression 
      of the patient's disease. OBJECTIVE: To assess the culprit medication(s) 
      responsible for hypersensitivity reactions following anti-VEGF injections for 
      macular degeneration. METHODS: Medication records were reviewed for each retinal 
      injection. All medications used in each procedure, including the anti-VEGF 
      therapy (aflibercept), topical anesthetics (tetracaine and proparacaine 
      hydrochloride), and antiseptic (povidine), were evaluated with skin testing. She 
      was additionally tested for alternative anti-VEGF therapies (ranibizumab and 
      bevacizumab) as she was thought to have allergies to these agents by prior 
      history. A test dose challenge was completed for aflibercept, ranibizumab, and 
      bevacizumab. RESULTS: Skin prick and intradermal testing were negative to 
      aflibercept, ranibizumab, bevacizumab, and povidine. Intradermal testing was 
      positive to tetracaine and proparacaine hydrochloride. The patient passed test 
      dose challenges to aflibercept, ranibizumab, and bevacizumab. Due to her positive 
      hypersensitivity testing to 2 ester anesthetics, the patient underwent skin prick 
      and intradermal testing to the amide anesthetic, lidocaine. This was negative and 
      the patient tolerated a graded challenge to lidocaine. She was deemed to have an 
      immunoglobulin E (IgE)-mediated hypersensitivity to ester-type local anesthetics. 
      She successfully resumed anti-VEGF therapy with an amide local anesthetic. 
      CONCLUSIONS: The reason for this consult was the concern for hypersensitivity to 
      a biologic anti-VEGF medication. The culprit allergen, the local anesthetic, 
      could have been overlooked without an assessment of all medications used during 
      the procedure. This case highlights the importance of a thorough allergy 
      evaluation of all medications used during procedures to determine the causative 
      agent.Chief Complaint: Eyelid swelling and rash after ophthalmic procedures for 
      macular degeneration.
FAU - Kleris, Renee S
AU  - Kleris RS
AD  - Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
FAU - Keswani, Anjeni
AU  - Keswani A
AD  - Department of Medicine, George Washington University School of Medicine and 
      Health Sciences, Washington, District of Columbia.
FAU - Lugar, Patricia
AU  - Lugar P
AD  - Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
AD  - Department of Medicine, Duke University Medical Center, Durham, North Carolina.
LA  - eng
GR  - T32 AI007062/AI/NIAID NIH HHS/United States
PT  - Journal Article
DEP - 20180501
PL  - United States
TA  - Allergy Rhinol (Providence)
JT  - Allergy & rhinology (Providence, R.I.)
JID - 101570968
PMC - PMC6028157
OTO - NOTNLM
OT  - anaphylaxis
OT  - angioedema
OT  - anti-VEGF treatment
OT  - contact dermatitis
OT  - drug allergy
OT  - intradermal testing
OT  - local anesthetic allergy
OT  - skin prick testing
OT  - urticaria
EDAT- 2018/07/07 06:00
MHDA- 2018/07/07 06:01
PMCR- 2018/05/01
CRDT- 2018/07/07 06:00
PHST- 2018/07/07 06:00 [entrez]
PHST- 2018/07/07 06:00 [pubmed]
PHST- 2018/07/07 06:01 [medline]
PHST- 2018/05/01 00:00 [pmc-release]
AID - 10.1177_2152656718763385 [pii]
AID - 10.1177/2152656718763385 [doi]
PST - epublish
SO  - Allergy Rhinol (Providence). 2018 May 1;9:2152656718763385. doi: 
      10.1177/2152656718763385. eCollection 2018 Jan-Dec.