Antimicrobial Desensitization: A Review of Published Protocols.

Chastain Chastain,Alegro Alegro,Hutzley Hutzley,Parekh Parekh

doi:10.3390/pharmacy7030112

Abstract

Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs that may otherwise cause hypersensitivity reactions. While no universal antimicrobial desensitization protocols exist, this review critically analyzes previously published desensitization protocols. The purpose of this review is to provide a greater insight for clinicians and institutions to ensure desensitization procedures are efficacious while minimizing potential for patient harm. With an increasing rate of antimicrobial resistance and the critical need to preserve antimicrobial agents, desensitization may represent another option in our antimicrobial stewardship toolkit.

Highlights

Inducing a state of drug tolerance may be required for patients unable to tolerate a particular drug or compound where no alternative is available [1]
Antimicrobial desensitization, a component of inducing drug tolerance, establishes a temporary state of drug tolerance that may otherwise cause immunoglobulin (Ig)E-mediated hypersensitivity reactions (HSRs) [2]. These procedures must be undertaken carefully due to the risk of severe adverse reactions (ADRs), such as urticaria, angioedema, gastrointestinal distress, pruritus, hypotension, wheezing, and flushing, which generally occur within one hour of drug exposure [3]
When selecting appropriate candidates for antimicrobial desensitization, the benefits of this intensive process must outweigh the potential harm from drug exposure

Summary

Introduction

Inducing a state of drug tolerance may be required for patients unable to tolerate a particular drug or compound where no alternative is available [1]. Antimicrobial desensitization, a component of inducing drug tolerance, establishes a temporary state of drug tolerance that may otherwise cause immunoglobulin (Ig)E-mediated hypersensitivity reactions (HSRs) [2]. These procedures must be undertaken carefully due to the risk of severe adverse reactions (ADRs), such as urticaria, angioedema, gastrointestinal distress, pruritus, hypotension, wheezing, and flushing, which generally occur within one hour of drug exposure [3]. Patients may experience anywhere from mild allergic reactions to life-threatening anaphylaxis Despite these potential risks, there may still be a need to utilize antimicrobials in patients that experience severe, immediate HSRs. For example, penicillin is the only available drug option to treat syphilis in pregnant women, and penicillin desensitization has been successfully performed in these patients [4,5]. Patients with Mycobacterium tuberculosis and a history of delayed HSR to rifampicin, isoniazid, and ethambutol were successfully desensitized [6]

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