Rapid desensitization for hypersensitivity reactions to medications.
Drug desensitization is the induction of temporary clinical unresponsiveness to drug antigens to which patients have presented severe hypersensitivity reactions. It is typically achieved by gradual reintroduction of small doses of drug antigens at fixed time intervals, and it is aimed at providing increased safety and protection from side effects, including anaphylaxis. Delivery of full therapeutic doses is achieved during desensitization, allowing patients to receive firstline chemotherapy, antibiotics, or monoclonal antibodies, as well as other drugs such as insulin, aspirin, and iron. Desensitizations are high-risk interventions. Inhibition of cellular activation mechanisms occurs during drug desensitization, allowing for the protective clinical outcomes and lack of side effects in the majority of cases, but the cellular and molecular inhibitory mechanisms are incompletely understood. The indication for desensitization protocols can only be done by trained allergists and immunologists and should be implemented as standard of care because of their high success rates and outcomes-demonstrated safety profile.
Castells
Mariana
M
Harvard Medical School, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, 1 Jimmy Fund Way, Smith Building, Room 626D, Boston, MA 02115, USA. mcastells@partners.org
D000707:Anaphylaxis / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D003888:Desensitization, Immunologic / Q000009:adverse effects*; D018450:Disease Progression; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000970:Antineoplastic Agents; D007328:Insulin; D007501:Iron; D001241:Aspirin