July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Allergic reaction to intravitreal injection of aflibercept, an anti-vascular endothelial growth factor drug
Author Affiliations & Notes
  • RYUZABURO KAWAKAMI
    opthalmology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  • RYO INOUE
    opthalmology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  • HAJIME BANDO
    opthalmology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  • TOSHIHIDE IKEDA
    opthalmology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  • KAZUYUKI EMI
    opthalmology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  • Footnotes
    Commercial Relationships   RYUZABURO KAWAKAMI, None; RYO INOUE, None; HAJIME BANDO, None; TOSHIHIDE IKEDA, None; KAZUYUKI EMI, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 1459. doi:
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      RYUZABURO KAWAKAMI, RYO INOUE, HAJIME BANDO, TOSHIHIDE IKEDA, KAZUYUKI EMI; Allergic reaction to intravitreal injection of aflibercept, an anti-vascular endothelial growth factor drug
      . Invest. Ophthalmol. Vis. Sci. 2018;59(9):1459.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose :
To report a patient’s allergic reaction to aflibercept, an anti-vascular endothelial growth factor (anti-VEGF) drug, and to describe the result of the drug-induced lymphocyte stimulation test (DLST).

Methods :
Clinical case report. We performed DLST of the anti-VEGF drugs, aflibercept, ranibizumab, and bevacizumab in the patient and in five healthy control subjects.

Results : A 77-year-old Asian man with age-related macular degeneration was treated with an intravitreal injection of aflibercept. The patient previously had one uncomplicated injection of aflibercept. After the second injection, the patient noticed worsening of vision and presented with anterior chamber fibrin, retinal hemorrhage, and periphlebitis. Considering the possibility of infectious endophthalmitis, 25-gauge pars plana vitrectomy was performed and antibiotic therapy started, and the patient’s symptoms improved. Two months after the operation, we performed a third injection because there was increased leakage due to choroidal neovascularization. After the injection, the patient presented with keratic precipitates but inflammation was mild. The patient was treated using topical steroid therapy and improved.
We suspected an allergic reaction to aflibercept and performed DLST of three anti-VEGF drugs. In the control patients, the DLST results were negative for all drugs. In our patient, however, the DLST of aflibercept and bevacizumab were positive while that of ranibizumab was negative. Therefore, we changed the anti-VEGF drug to ranibizumab. We performed the injection of ranibizumab three times and there were no allergic hypersensitivity or resulting complications.

Conclusions : Some patients are allergic to anti-VEGF drugs. DLST should be performed for identifying appropriate drugs when drug-induced hypersensitivity is suspected.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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