Rituximab Infusion Reaction Prophylaxis Using Histamine Receptor Blockade, Prednisone and Colchicine

An 80 year old female with large cell lymphoma presented with a history of 2 infusion reactions to rituximab 2 years prior. The initial reaction occurred within minutes, after the intravenous administration of a few milliliters of her first infusion. The reaction consisted of diffuse erythema, shortness of breath, and hypotension. The patient described having uncontrollable shaking for several hours after the infusion. The second infusion was attempted a few days later. Prophylactic treatment was administered with acetominophen, diphenhydramine, and parenteral dexamethasone given prior to the second retuxamab infusion. A 1:10 dilution of rituxamab was utilized. After infusion of a few milliliters, she developed an identical reaction to that observed with the first infusion.