Tuesday: was my third Rituxan® infusion. Walloped with IV steroids and IV Benadryl™ (both as pre-meds to prevent a reaction to infusion), the appropriate labs had been drawn.The premeds are given to prevent a reaction to the infusion.
Reaction to infusion? Essentially, the administration of any foreign drug is likely to elicit some response from the immune system. How and why could I react to this infusion? Well, think of this just like the immune system in lupus. There is a foreign invader (antigen and in this case, Rituxan®) and the body can mount an immune response with antibodies. The antibodies which attack foreign cells are called auto-antibodies.
If the body does mount a response, it usually is diminished with the body’s own antihistamines. The administration of IV steroids and IV Benadryl, an antihistamine usually prevents this reaction from occurring and treats it it it does. Symptoms of a reaction might be itchiness, hives, throat tightening, airway obstruction and distress and respiratory arrest.
I find the following video an easy way of remembering the definition of antibodies and antigens and auto-antibodies and their difference.
An hour after the infusion began, the nurse increased the rate as she had done 2 times before, but shortly therafter, I got a very intense itch on my back. I didn’t consider an infusion reaction; rather, I thought of dry skin on my back: because I forgot to lotion!
Just as quickly as the nurse stopped the infusion, she looked at my very itchy back. It was reddened and raised and blotchy red. My face was reddened and so was my neck, I was having a reaction. The infusion was turned off for an hour and when she resumed the infusion, she started it at a much slower rate and I was fine.
An update on my second Rituxan™ infusion: my only side effect, mild flushing was gone in less than a day. Remember, doses for immunotherapy are lower than cancer chemotherapy, so, reactions most likely differ.
After the IV Benadryl™ and steroid I was given (to prevent most reactions) I slept. I slept during the whole infusion, except for lunch when I emerged from my warm blanket and slumber-when a sandwich and beverage was delivered. I was chomping away one minute and the next minute, I was the awakened by my nurse, “Your teeth have fallen out (I wear a partial plate) and your sandwich is smushed into your chest!”
More important, why Rituxan™, and why does it work? There are two types of cells in the humoral immune system; B cells and T cells. It is the job of the B cells is to fight infection which it does by producing antibodies.When the B cells are suppressed, antibody production is decreased and disease activity is decreased. So suppress away, right? We don’t want disease activity!
Not so fast! When you suppress the B cells, you also suppress the body’s ability to fight infection, so infection is a common side effect of Rituxan™. So the risk of infection is a common risk that needs to be weighed. However, this risk can be minimized with good hand-washing, not exposing oneself to people who are ill, wearing a mask in large public places or and asking others to be respectful of your infectious needs.
My rheumatologist called; ‘Rituxan has been approved by your insurance company; so the infusion center will be calling you to schedule.’
‘Wait, not so fast! I have a few questions about Rituxan, basic questions: like why you chose it, what to expect, what the goals are and what side effects there are.’ The doc explained the action of Rituxan (Rituximab™).
It works by supressing B cell activity (remember the B cells and T cells?) which decrease much of the inflammation caused by lupus and Sjogren’s Syndrome. Unfortunately, also decreased would be my body’s ability to fight infections. Good hand-washing would was a must as would be not staying in crowds without a mask.
The symptoms? Never a problem at rest, shortness of breath was always a huge problem when I exerted myself; all I had to do was to walk 10 yards and the shortness of breath was terrible, debilitating. Where had this come from? From left field, I know!
To someone who had been athletic her whole life and relied on her lungs to fuel the heart with enough oxygenated blood to power my muscles in a triathlon, being short of breath with such minimal exertion was quite a lifestyle change.
Stay tuned to this channel for updates on my weekly treatments with Rituxan as I take this journey. For now, infusions are scheduled once a week x 4 weeks.