Triad of Acute Infusion-Related Reactions Associated with Liposomal Amphotericin B: Analysis of Clinical and Epidemiological Characteristics

We investigated the clinical characteristics and treatment of patients with a distinctive triad of acute infusion-related reactions (AIRRs) to liposomal amphotericin B (L-AMB) via single-center and multicenter analyses. AIRRs occurred alone or in combination within 1 of 3 symptom complexes: (1) chest pain, dyspnea, and hypoxia; (2) severe abdomen, flank, or leg pain; and (3) flushing and urticaria. The frequency of AIRRs in the single-center analysis increased over time. Most AIRRs (86%) occurred within the first 5 min of infusion. All patients experienced rapid resolution of symptoms after intravenous diphenhydramine was administered. The multicenter analysis demonstrated a mean overall frequency of 20 % (range, 0%–100%) of AIRRs among 64 centers. A triad of severe AIRRs to L-AMB may occur in some centers; most of these reactions may be effectively managed by diphenhydramine administration and interruption of L-AMB infusion. For many years, amphotericin B deoxycholate (D-AMB) was the only therapeutic option for the treat-ment of invasive mycoses. Its clinical utility, however, has been restricted by dose-limiting nephrotoxicity and infusion-related reactions (IRRs) [1, 2]. Intra-venous infusions of D-AMB have been commonly as