Desensitization for drug allergy.
OBJECTIVE
Desensitization for drug allergy is the induction of temporary clinical unresponsiveness to drug antigens. Gradual reintroduction of small doses of drug antigen at fixed time intervals allows for the delivery of full therapeutic doses, protecting patients from anaphylaxis. Rapid desensitizations permit the use of essential antibiotics in severely infected allergic patients or aspirin in aspirin-sensitive cardiac patients undergoing revascularization. We review the indications and outcomes of recent protocols for desensitization to antibiotics and aspirin.


RESULTS
Despite the success of rapid desensitizations, the cellular and molecular inhibitory mechanisms are incompletely understood. In-vitro mast cell and basophil models implicate molecular signaling molecules syk and STAT6. Rapid desensitization protocols treat type I mast cell/IgE dependent reactions, such as anaphylaxis, as seen with sensitization to penicillin, cephalosporins, and other antibiotics. Anaphylactoid reactions induced upon initial drug exposure and with similar clinical presentation as immunoglobulin E-mediated reactions, as seen with aspirin, vancomycin and taxenes, can also be treated with rapid desensitizations.


CONCLUSIONS
Successful rapid desensitization protocols for treating adverse reactions to antibiotics and aspirin allow for treatment of critically infected patients and aspirin-sensitive cardiac patients. Standardized protocols with high success rates should be implemented as the standard of care.
Castells
Mariana
M
Harvard Medical School, Boston, Massachusetts, USA. mcastells@partners.org
D000707:Anaphylaxis / Q000276:immunology / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000276:immunology; D001241:Aspirin / Q000009:adverse effects / Q000276:immunology; D001491:Basophils / Q000276:immunology; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007239:Infections / Q000188:drug therapy / Q000276:immunology; D047908:Intracellular Signaling Peptides and Proteins / Q000276:immunology; D008407:Mast Cells / Q000276:immunology; D018448:Models, Immunological; D009204:Myocardial Revascularization; D011505:Protein-Tyrosine Kinases / Q000276:immunology; D050800:STAT6 Transcription Factor / Q000276:immunology; D015398:Signal Transduction / Q000187:drug effects / Q000276:immunology; D000072377:Syk Kinase
D000900:Anti-Bacterial Agents; D047908:Intracellular Signaling Peptides and Proteins; D050800:STAT6 Transcription Factor; C494101:STAT6 protein, human; D007073:Immunoglobulin E; D011505:Protein-Tyrosine Kinases; C000606896:SYK protein, human; D000072377:Syk Kinase; D001241:Aspirin