GNRH analogues


These drugs are used to induce ovulation and in treatment of endometriosis, polycystic ovary disease, precocious puberty, and prostate cancer.
 
Tripterolin, Gonadorelin, Buserelin, Leuprorelin (leuprolide), Nafarelin, Goserelin.
 
Incidence
Local reactions: 0 to 13%.
 
General reactions are rare.
 
Risk factors
Route of administration (constant infusion > intermittent use).
 
Length of treatment.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: flush, pruritus, local erythema, urticaria, vasculitis (sometimes delayed)
 
Respiratory: sneeze, bronchospasm.
 
Diagnostic methods
Cutaneous testing.
 
Skin-prick tests positive in various concentrations for gonadorelin, buserilin, goserilin, leuprorelin.
 
Specific IgE (RAST): a few cases published.
 
Specific IgG (RIA): controversial role.
 
MIF one case positive with triptorelin
 
Skin-biopsy: one case of allergic vasculitis with triptorelin.
 
Mechanisms
IgE-mediated hypersensitivity (immediate positive skin tests, specific IgE).
 
Type III reaction (one case).
 
Non-specific histamine release.
 
Management
Avoidance of all GnRHs.

References

  1. Raj S.G, Karadsheh A.J, Guillot R.J, Raj M.H, Kumar P, "Case report: systemic hypersensitivity reaction to goserelin acetate", Am. J. Med. Sci., 1996; 312 (4): 187-90
  2. Amichai B, Grunwald M.H, Halevy S, "Allergic vasculitis induced by Decapeptyl*: confirmation by macrophage migration inhibition factor (MIF) test", Eur. J. Obstet. Gynecol. Reprod. Biol., 1993; 52 (3): 217-8
  3. Letterie G.S, Stevenson D, Shah A, "Recurrent anaphylaxis to a depot form of GnRH analogue", Obstet. Gynecol., 1991; 78 (5.2): 943-6
  4. Foster W.G, Jarrell J.F, Dolovich J, Yung-Lai E.V, "Immunoglobulin-mediated hypersensitivity in response to long-term treatment with gonadorelin hydrochloride (Factrel) in a female patient", Am. J. Obstet. Gynecol., 1989; 160 (4): 979-83
  5. Mac Leod T.L, Eisen A, Sussman G.L, "Anaphylactic reaction to synthetic luteinizing hormone-releasing hormone", Fertil. Steril., 1987; 48 (3): 500-2.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.