PMC10285465_01
Evolution of plasma triglycerides before and after the volanesorsen desensitization protocol.
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F1
During the course of the month, the patient received volanesorsen, and she sustained normal serum triglyceride levels (<200 mg/dl, Figure 1). Over the 8 weeks following the cessation of volanesorsen, plasma triglyceride levels increased steadily until they reached 2,500 mg/dl, a level that represents a stage of critical risk for acute pancreatitis (Figure 1). The patient continued to receive volanesorsen weekly for 3 months after desensitization with good control of plasma TG (Figure 1), and was then admitted again to the hospital with generalized myalgia, arthralgia, chills, malaise, and fainting with functional limitation, 6 h after the application of volanesorsen (in an upper limb).
Clinical presentation of the patient. (A) and (B) Itchy welts, nettle rash, and angioedema 20 min after the application of volanesorsen. (C) Confirmation of hypersensitivity to volanesorsen. Volanesorsen 285 mg/1.5 ml (190 mg/ml), prick test was performed with the undiluted solution and intradermal skin tests 1/100 (1.9 mg/ml) and 1/10 (19 mg/ml). In both dilutions, the increase in the initial papule was more than 20% of its size and there was a halo of associated erythema.
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F2
At the fifth dose, 20 min after administration, the patient developed facial angioedema, accompanied by evanescent, severely pruriginous, erythematous, and papular lesions localized in the torso, face, and arms, compatible with urticaria (Figure 2, panels A-C).
Desensitization protocol for volanesorsen.
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F3
Castells (Section 3, and Figure 3).