title: Safety, Costs, and Efficacy of Rapid Drug Desensitizations to Chemotherapy and Monoclonal Antibodies.
abstract: Rapid drug desensitization (RDD) is used to address hypersensitivity reactions to chemotherapeutics and monoclonal antibodies, allowing patients to be treated with optimal pharmacological agents. RDD protocols are tailored to each individual patient's reaction and needs, and protect against anaphylaxis, but overall risks, costs, and benefits have not been determined.
  
  
  
  We investigated the safety, efficacy, costs, and life expectancy of patients in a large population undergoing RDD.
  
  
  
  We analyzed 2177 RDD procedures performed in 370 patients with cancer, vasculitis, and hematological and connective tissue diseases who presented 402 reactions. A subgroup of carboplatin allergic patients with ovarian cancer treated with RDD was analyzed for costs and life expectancy and compared with a nonallergic control group.
  
  
  
  RDD allowed all patients to receive safely the full dose of the medication to which they were reactive. A gradual increase in the fraction of outpatient desensitizations from 81% to 98% was achieved through risk stratification. Of the 2177 desensitizations, 93% had no or mild reactions whereas 7% had moderate to severe reactions, which did not preclude the completion of the treatment, and there were no deaths. Overall health costs in the carboplatin allergic group were not higher than those in the nonallergic group treated with standard of care. Administration of carboplatin through RDD was as effective as standard administration with a nonsignificant increase in life expectancy in desensitized patients as compared with nonallergic, nondesensitized controls.
  
  
  
  RDD is cost effective and safe for allergic patients with cancer and chronic disease to remain on first line therapy.
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: David
authors.initials: D
authors.lastname: Sloane
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY.
authors.forename: Usha
authors.initials: U
authors.lastname: Govindarajulu
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Jacob
authors.initials: J
authors.lastname: Harrow-Mortelliti
authors.affiliation: Dana Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors.forename: William
authors.initials: W
authors.lastname: Barry
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Florence Ida
authors.initials: FI
authors.lastname: Hsu
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: David
authors.initials: D
authors.lastname: Hong
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Tanya
authors.initials: T
authors.lastname: Laidlaw
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Ross
authors.initials: R
authors.lastname: Palis
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Henry
authors.initials: H
authors.lastname: Legere
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Supinda
authors.initials: S
authors.lastname: Bunyavanich
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Breslow
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Duane
authors.initials: D
authors.lastname: Wesemann
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Nora
authors.initials: N
authors.lastname: Barrett
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brennan
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Hey Jin
authors.initials: HJ
authors.lastname: Chong
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Anne
authors.initials: A
authors.lastname: Liu
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: James
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Laura
authors.initials: L
authors.lastname: Fanning
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kyin
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Katherine
authors.initials: K
authors.lastname: Cahill
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Lora
authors.initials: L
authors.lastname: Bankova
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Ashly
authors.initials: A
authors.lastname: Lynch
authors.affiliation: Dana Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Berlin
authors.affiliation: Dana Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors.forename: Susana
authors.initials: S
authors.lastname: Campos
authors.affiliation: Dana Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors.forename: Charles
authors.initials: C
authors.lastname: Fuchs
authors.affiliation: Dana Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors.forename: Robert
authors.initials: R
authors.lastname: Mayer
authors.affiliation: Dana Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors.forename: Ursula
authors.initials: U
authors.lastname: Matulonis
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: mcastells@partners.org.
authors.forename: Mariana
authors.initials: M
authors.lastname: Castells
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000191:economics / Q000379:methods; D004342:Drug Hypersensitivity / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents
keywords: Carboplatin; Chemotherapeutic agents; Cost; Drug desensitization; Drug hypersensitivity; Efficacy; Monoclonal antibodies; Safety