Abstract
The increased use of antineoplastic drugs has been associated with a rising number of hypersensitivity reactions to these drugs, which has led to a growth in the demand for assistance from allergy services. The involvement of an allergist is essential to ensure that these patients with hypersensitivity reactions continue to be able to receive appropriate first-line treatment. Chemotherapy and biological agents have specific handling requirements and all the allergy departments involved in the diagnosis and therapeutic management of patients reacting to these drugs should find the means to guarantee safety. There are currently several guidelines on the safe handling of hazardous drugs for healthcare workers. However, specific recommendations are lacking for reducing occupational exposure in staff working in the allergy departments and managing these drugs for the diagnosis and management of hypersensitivity reactions. This review article focuses on the safe handling strategy of the allergy department in the Ramón y Cajal University Hospital and provides details of its implementation and experience over 10 years. This protocol could improve the knowledge of safe handling of antineoplastic drugs in allergy procedures.
Highlights
Over the last two decades, referrals to the allergy departments for patients with confirmed/suspected drug hypersensitivity reactions (DHRs) to antineoplastic drugs have increased (1, 2)
Dermal absorption is generally regarded as the primary route of exposure in healthcare providers handling hazardous drugs (HDs) (11) and is a route that becomes relevant during the reading of STs performed in the allergy department
When the allergy department includes the diagnostic and therapeutic management of DHRs to antineoplastic drugs in its clinical practice, it should implement a culture of safe handling of hazardous antineoplastic drugs (HADs)
Summary
Over the last two decades, referrals to the allergy departments for patients with confirmed/suspected drug hypersensitivity reactions (DHRs) to antineoplastic drugs have increased (1, 2). A program for the safe handling of HDs was developed and implemented with the aim of protecting the health of healthcare providers who could be exposed to HDs in their work practices This program was the result of collaboration between members of a multidisciplinary team comprising an allergist, a pharmacist, a nurse, and occupational health physicians and was guided by national and international documents (6, 8, 11–14) and by institutional recommendations from the pharmacy department at the RCUH. The program for the safe handling of HDs in the allergy department at the RCUH initially included a workplace-specific risk assessment that identified health and safety hazards; the best strategies to minimize occupational exposure were sought (15). The risk assessment process considered the following: 1. Type of HDs handled: Prior to handling any HD in the allergy department, knowledge of toxicity, including cytotoxicity, carcinogenicity, genotoxicity, teratogenicity, and organ toxicity at low doses, is required (6, 11, 15)
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