Successful Desensitization of a Patient with Rituximab Hypersensitivity

Table 1

Rituximab desensitization protocol.

Step	Solution	Rate (mL/h)	Time (min)	Dose	Total dose
1	1	2.0	15	0.015
2	1	5.0	15	0.037
3	1	10.0	15	0.075
4	1	20.0	15	0.150	0.277
5	2	5.0	15	0.375
6	2	10.0	15	0.750
7	2	20.0	15	1.500
8	2	40.0	15	3.000	5.625 (1–8: 5.902); 750–5.902: 744 mg will be given in next steps
9	3	10.0	15
10	3	20.0	15
11	3	40.0	15
12	3	75.0	240

Solution 1: 250 mL, 5% dextrose, /0.8 mL  rituximab (0.03 mg/mL: 1 : 100 of total dose, 250 mL/7.5 mg).
Solution 2: 250 mL, 5% dextrose, /7.5 mL rituximab (0.30 mg/mL: 1 : 10 of total dose, 250 mL/75 mg).
Solution 3: 250 mL, 5% dextrose, /74.4 mL rituximab.
Premedication: 20 minutes before pheniramine 45.5 mg IV, prednisolone 100 mg IV, and famotidine 20 mg IV.