How to manage anaphylaxis due to Tezspire?
Patient's Query
Hello doctor, A 54-year-old female presents with anaphylaxis symptoms. 30 minutes post-Tezspire injection (3rd dose), she had urticaria, angioedema, wheezing, and blood pressure of 95/60 mmHg. The current medications taken are Fluticasone/Vilanterol 200/25, Montelukast, and Amlodipine. Previous doses were well-tolerated except for mild injection site reactions. She was treated with epinephrine, antihistamines, and steroids. The tryptase level is 25 µg/L (baseline 5.8). Should we permanently discontinue Tezspire? What workup is needed to evaluate this reaction? Are there specific antibody tests available? What alternative biologics should we consider given her reaction profile? Please suggest.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Tezspire Discontinuation:
Yes, permanent discontinuation is advised due to anaphylaxis and elevated tryptase, indicating mast cell activation. Re-exposure poses a significant risk.
Workup:
Do serum tryptase (repeat at baseline, post-reaction trend), Tezepelumab-specific IgE (immunoglobulin E), and basophil activation test (if available). Skin testing (under allergist supervision) and mast cell disorder screening (if there is recurrent anaphylaxis) can be done.
Alternative:
Dupilumab (IL-4/IL-13) or Mepolizumab (IL-5) for eosinophilic asthma can be taken. Omalizumab (IgE-targeting) can be taken if an allergic phenotype is present. Consult an allergist before switching therapy.
I hope this helps.
Thank you and take care.
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