Methotrexate hypersensitivity reactions in pediatrics: Evaluation and management.

Reports of hypersensitivity reactions (HSRs) to MTX are limited to single case studies. We retrospectively reviewed HSRs to MTX during a 12-year period in our tertiary care pediatric center. Seven patients were evaluated for HSRs to MTX. Skin testing was positive in one of the four patients tested. One patient underwent successful graded challenge to MTX. Seventeen desensitizations to MTX were successfully performed in the other six patients. Skin testing, graded challenge, and desensitization were safe and effective procedures in the evaluation and management of patients with HSRs to MTX in our pediatric population.

Rituximab Desensitization in Pediatric Patients: Results of a Case Series.

Rituximab is a monoclonal antibody (mAb) primarily used to treat oncologic and autoinflammatory conditions. Although hypersensitivity reactions (HSRs) and desensitization protocols to mAbs have been well described in adults, the experience in the pediatric population is very limited. We sought to determine the safety and efficacy of desensitization to rituximab in the pediatric population at our institution. We retrospectively reviewed the experience with HSRs and desensitization to rituximab during a 5-year period in our tertiary care pediatric center, including reaction evaluation, premedication regimens, and desensitization procedures and protocols. A total of 17 desensitizations to rituximab were performed in three patients. A 14-year-old patient underwent successful desensitization to rituximab using a published adult protocol without incident. Two younger patients (ages 7 years and 23 months) experienced significant reactions during initial desensitization attempts. Therefore, we designed a modified desensitization protocol to rituximab, with particular attention to the rate of infusion as mg/kg/h. This new patient weight-based protocol was successfully used in a total of 13 desensitizations in these two patients. Desensitization to rituximab was a safe and effective procedure in our pediatric population. We present a new patient weight-based desensitization protocol for pediatric patients who develop HSRs to rituximab, with particular usefulness for younger pediatric patients and potential utility in pediatric patients with HSRs to other mAbs.

Ethnic Identity as a Moderator against Discrimination for Transracially and Transnationally Adopted Korean American Adolescents.

Despite the growing practice of international adoption over the past 60 years, the racial and ethnic experiences of adopted youth are not well known. This study examined the moderating role of ethnic identity in the association between racial/ethnic discrimination and adjustment among transracially, transnationally adopted Korean American adolescents (N = 136). Building on self-categorization theory and past empirical research on Asian Americans, it was hypothesized that ethnic identity would exacerbate negative outcomes associated with discrimination. The moderating role of ethnic identity was found to vary by specific ethnic identity dimensions. For individuals with more pride in their ethnic group (affective dimension of ethnic identity), discrimination was positively associated with externalizing problems. For individuals with greater engagement with their ethnic group (behavioral dimension of ethnic identity), discrimination was positively associated with substance use. By contrast, clarity regarding the meaning and importance of one's ethnic group (cognitive dimension of ethnic identity) did not moderate the relationship between discrimination and negative outcomes.