Allergie à la cyclosporine intraveineuse

Cyclosporine is a powerful immunosuppressive agent utilized in transplantation. Amongst its side effects, anaphylactic reactions are rare, occuring in 0.1% of treated patients. We describe the case of a 13-year-old boy who presented an anaphylactic shock during his first intraveinous cyclosporine injection. The diagnosis was not immediatly made since oral cyclosporine was quickly introduced. Three weeks later, he experienced a second anaphylactic shock while intraveinous cyclosporine was introduced again because of a suspicion of intestinal occlusion. Skin prick tests to intraveinous cyclosporine were positive. We suggest the possibility of an IgE-dependent allergy to Cremophor EL, present in the intraveinous but not the oral form of cyclosporine and discuss the literature.