Journal of the American Pharmacists Association : JAPhA •
Alpha-gal syndrome (AGS) is a tick-borne allergic condition triggered by galactose-alpha-1,3-galactose, a carbohydrate found in mammalian products. This case report highlights the perioperative challenges of managing AGS in a patient undergoing Roux-en-Y gastric bypass, a common bariatric surgical procedure. A 53-year-old male with AGS was scheduled for robotic-assisted Roux-en-Y gastric bypass with potential hiatal hernia repair. The patient exhibited severe sensitivity to beef but lower reactivity to pork products, complicating the use of porcine-derived heparin for venous thromboembolism prophylaxis. After careful evaluation, low-molecular-weight heparin (enoxaparin) was selected as the anticoagulant, with 40 mg administered preoperatively. The patient underwent surgery without adverse reactions or bleeding complications. This case underscores the complexities of AGS management in surgical settings, particularly regarding the selection of anticoagulants. While nonporcine alternatives exist, their safety and efficacy in bariatric surgery remain underexplored. The successful use of enoxaparin in this case suggests that a tailored approach, supported by multidisciplinary collaboration, can mitigate risks. This report highlights the need for further research to establish guidelines for anticoagulation in patients with AGS undergoing surgery. Enhanced awareness and individualized care are critical to ensuring optimal outcomes in this unique patient population.
Van Tine BA, Govindarajan R, Attia S, Somaiah N, Barker SS, et al.
Journal of oncology practice •
Olaratumab is a human monoclonal immunoglobulin G1 antibody against platelet-derived growth factor receptor-α. We report the nature and frequency of infusion-related reactions (IRRs) with olaratumab in clinical trials and postmarketing reports. Data from patients exposed to olaratumab across nine clinical trials were reviewed for IRRs. Blood samples were also analyzed for pre-existing immunoglobulin E anti-galactose-α-1,3-galactose (anti-α-Gal) antibodies. In the clinical trials, IRRs were identified in 70 of 485 patients (14.4%). The most frequent symptoms included flushing, fever or chills, and dyspnea. For 68 of 70 patients (97.1%), the first IRR occurred during the first two cycles of treatment. Grade 3 or worse IRRs were reported in 11 patients (2.3%), all during the first infusion and usually within 15 minutes of the start of the infusion. One IRR-related fatality (0.2%) occurred in a nonpremedicated patient with grade 3 or worse cardiac comorbidities. There was an association between grade 3 or worse IRRs and pre-existing anti-α-Gal antibodies, with a trend toward higher IRR rates in US geographies known to have a higher prevalence of anti-α-Gal antibodies. IRRs in postmarketing reports were consistent in nature and severity with those in the clinical trials. Premedication with corticosteroids and antihistamines should occur in all patients before olaratumab infusion, as indicated in labels in the United States and the European Union. Patients receiving olaratumab should be monitored for IRRs in a setting where resuscitation equipment is available for the treatment of IRRs.