title: Indications, protocols, and outcomes of drug desensitizations for chemotherapy and monoclonal antibodies in adults and children.
abstract: Advances in the understanding of various malignancies and chronic inflammatory diseases has led to the development of better treatment options for prolonging patient survival and minimizing morbidity. The recognition of "first-line" chemotherapy and monoclonal agents for these conditions has given more urgency to the need to re-administer these drugs in cases of drug hypersensitivity reactions. Therefore, in these cases, not only is desensitization considered when there is no alternative therapy available but also when alternative treatments are considered therapeutically inferior and/or more toxic. In this article, we describe the steps involved in the evaluation of these patients, factors to consider before making a decision to desensitize, the implementation of desensitization protocols, and the outcomes of such procedures.
authors.affiliation: Division of Rheumatology, Immunology, and Allergy; Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: dhong@partners.org.
authors.forename: David I
authors.initials: DI
authors.lastname: Hong
authors.affiliation: Harvard Medical School, Boston, Mass; Division of Immunology, Department of Medicine, Boston Children's Hospital, Boston, Mass. Electronic address: anahita.dioun@childrens.harvard.edu.
authors.forename: Anahita F
authors.initials: AF
authors.lastname: Dioun
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D002648:Child; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012882:Skin Tests; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents
keywords: Adult; Allergy; Chemotherapeutic agent; Drug challenge; Drug desensitization; HSR; Hypersensitivity reaction; Hypersensitivity reactions; Monoclonal antibody; Pediatric; Skin testing; mAb