Desensitization to Depot Preparation of Gonadotropin-Releasing Hormone Agonist in Two Pediatric Patients

Background: Long-acting gonadotropin-releasing hormone agonists (GnRHa) are commonly used to treat central precocious puberty (CPP). GnRH agonists suppress the secretion of gonadotropins, thus preventing pubertal progression and the consequent reduced adult height secondary to accelerated fusion of growth plates. Although rare, adverse allergic reactions, including anaphylaxis, have been reported to depot GnRHa agents. In such cases, no alternative therapeutic options exist, as replacement with another GnRHa has been reported to cause similar allergic reactions. Therefore, a desensitization protocol to an existing depot GnRHa preparation was undertaken, to allow 2 young girls suffering from CPP to receive this vital therapy.

Objectives: To describe our successful experience in desensitization to depot preparations of GnRHa

Methods: Two girls (aged 8, 10 years) with central precocious puberty had developed a generalized urticarial rash upon treatment with GnRHa. Intradermal skin testing with the culprit agent was positive. A desensitization protocol was developed, being comprised of premedication with antihistamines and corticosteroids prior to GnRHa injection. These monthly injections were administered during a 24-hour hospitalization to monitor for adverse events.

Results: One of the patients had successfully completed GnRHa therapy for her condition, using this protocol. The second is currently being treated with full dose GnRHa (IM Decapeptyl 3.75 mg), with no significant adverse events.

Conclusion: Desensitization is a pragmatic therapeutic option for children with a hypersensitivity reaction of GnRH agonists, whereupon no alternative treatment options are available.