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Comment: Desensitization to Hydroxychloroquine MICHAL MATES, MD; GIDEON NESHER, MD, Rheumatology Service, Department of Internal Medicine, Shaare-Zedek Medical Center, PO Box 3235, Jerusalem, 91031 Israel. E-mail: rheum@szmc.org.il Drs. Mates and Nesher reply We appreciate Dr. Sontheimer's comprehensive discussion on hydroxychloroquine (HCQ) hypersensitivity reaction1, stimulated by our recent report describing a protocol of desensitization to HCQ2. We would like to clarify and comment on several issues raised by this editorial. The manufacturer of Plaquenil (hydroxychloroquine sulfate) given to the patients was Sanofi-Synthelabo (Paris, France). The same product was used in the desensitization procedure. HCQ rechallenge was attempted in one of our 4 patients prior to desensitization, and resulted in very rapid reoccurrence of diffuse rash, associated with shortness of breath. As a consequence, we did not try to rechallenge the other 3 patients. Such a rechallenge could indeed have been uneventful in some of the other patients, but given our experience with one patient and the severity of the rash in the others, we elected not to attempt any more rechallenges. Dr. Sontheimer suggests another management option to consider when faced with patients who experience HCQ cutaneous adverse reaction — a trial of chloroquine. Although challenge with chloroquine may not result in reexpression of the rash, one should bear in mind the increased retinal toxicity of chloroquine3,4. Therefore, attempting desensitization to HCQ seems preferable. We appreciate the attention our report has created, and hope it would enable more patients to safely continue treatment with this medication. 2. Mates M, Zevin S, Breuer GS, Navon P, Nesher G. Desensitization of hydroxychloroquine — experience of 4 patients. J Rheumatol 2006;33:814-6. [MEDLINE] 3. Finbloom DS, Silver K, Newsome DA, Gunkel R. Comparison of hydroxychloroquine and chloroquine use and the development of retinal toxicity. J Rheumatol 1985;12:692-4. [MEDLINE] 4. Avina-Zubieta JA, Galindo-Rodriguez G, Newman S, Suarez-Almazor ME, Russell AS. Long term effectiveness of antimalarial drugs in rheumatic diseases. Ann Rheum Dis 1998;57:582-7. [MEDLINE]
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