title: Medication Desensitization: Characterization of Outcomes and Risk Factors for Reactions.
abstract: BACKGROUND
  Although its mechanisms are poorly understood, desensitization has been used to induce a temporary state of immune unresponsiveness in patients who have IgE-, non-IgE-, or pharmacologically mediated reactions when a drug has no alternatives.
  
  
  OBJECTIVE
  The purpose of this study was to characterize the outcomes and identify risk factors for reactions during drug desensitization.
  
  
  METHODS
  A retrospective review of electronic medical records of adult patients undergoing drug desensitization from January 1, 2011, to December 31, 2013, was conducted in 2 intensive care units at a tertiary medical center. We used multivariate analysis to determine if specified risk factors were associated with reacting during the desensitization. Reactions were classified according to the pretest probability prior to desensitization, and then, reactions during desensitization were classified based on the occurrence of cutaneous reactions as follows: successful with no reaction, mild reaction, moderate reaction, or failed. Failure could result from any systemic allergic or cutaneous reaction resulting in procedure termination. The desensitizations were also assessed to determine if the patient required de-escalation secondary to a reaction.
  
  
  RESULTS
  A total of 88 desensitizations were performed in 69 patients. Desensitization was completed with no cutaneous reaction in 85% of patients. No baseline characteristic, medication class (P = 0.46), or indication for desensitization (P = 0.59) was associated with having a reaction. Reported histories of urticaria (P < 0.0001) and labored breathing (P = 0.003) during prior exposure were significant in identifying patients who might have a reaction during desensitization. However, neither history of urticaria nor labored breathing was independently associated with having a reaction in multivariate analysis (OR = 0.979, 95% CI = 0.325-2.952, P = 0.970, and OR = 1.626, 95% CI = 0.536-4.931, P = 0.739, respectively).
  
  
  CONCLUSIONS
  Drug desensitization is safe for patients who have no alternative for therapy. Reported allergy histories of urticaria and labored breathing are both associated with having a reaction during the desensitization process.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Taryn S
authors.initials: TS
authors.lastname: Murray
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Arthur P
authors.initials: AP
authors.lastname: Wheeler
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Phillips
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Ryszard T
authors.initials: RT
authors.lastname: Dworski
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA joanna.stollings@vanderbilt.edu.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Stollings
mesh_terms: D000328:Adult; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
keywords: allergy; anaphylaxis; basic pharmacology; critical care; desensitization; immunology