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Case report
Pegloticase hypersensitivity desensitisation: an outpatient, 3-bag, 12-step protocol
  1. John K Botson
  1. Orthopedic Physicians Alaska, Anchorage, Alaska, USA
  1. Correspondence to Dr John K Botson; jbotson{at}


Pegloticase is a highly effective treatment for refractory gouty arthropathy. Unfortunately, the medication is also highly immunogenic, leading to infusion reactions, loss of drug efficacy and anaphylaxis. Desensitisation, a procedure to tolerise a patient to a medication previously causing a hypersensitivity reaction, has been used successfully in oncology for chemotherapy treatment. The same principle can be applied to other specialties. Presented is a 48-year-old man who experienced multiple, severe infusion reactions to pegloticase administered for gouty arthropathy. A rapid desensitisation was performed using an outpatient, 3-bag, 12-step protocol, which allowed multiple additional pegloticase infusions to be performed without incident. This is the first reported case of a patient successfully desensitised after an infusion reaction to pegloticase. Though additional patients are needed to confirm these results, this represents a significant opportunity to recapture and continue pegloticase therapy in patients treated for refractory gouty arthropathy.

  • rheumatology
  • immunology

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  • Contributors JKB was solely responsible for all aspects of the work including drafting, reviewing and approving the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JKB reports personal fees from Horizon Therapeutics, outside the submitted work.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.