Abstract
Background:Rapid drug desensitization (RDD) allows first-line therapies in patients with immediate drug hypersensitivity reactions (DHR) to chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb). Desensitization in delayed drug reactions has traditionally used slow protocols extending up to several weeks; RDD protocols have been scarcely reported.Patients and Method:We retrospectively analyzed the patients referred to the Allergy Department, who had experienced a delayed DHR (> 6 h) related to a ChD or mAb and underwent an RDD protocol. The rate of successful administration of the offending drug and the presence of adverse reactions were evaluated.Results:A total of 93 RDDs were performed in 11 patients (including 6 men and 5 women, with a median age of 61 years). The primary DHR were maculopapular exanthema (MPE) (8), generalized delayed urticaria (1), MPE with pustulosis and facial edema (1), and facial edema with desquamative eczema (1). The meantime for the onset of symptoms was 3 days (range 1–16 days). RDD was performed using a protocol involving 8–13 steps, with temozolomide (25), bendamustine (4), rituximab (9), infliximab (24), gemcitabine (23), and docetaxel (8), within 4.6–6.5 h. Sixteen breakthrough reactions were reported during the RDD (17.2 %) in 5 patients; all were mild reactions including 11 delayed and 5 immediate reactions. All patients completed their treatment.Conclusions:RDD is a potentially safe and effective procedure in patients suffering from delayed reactions to ChD and mAb. It allows them to receive full treatment in a short period, thereby reducing time and hospital visits.
Highlights
Rapid drug desensitization (RDD) has shown to be a safe and effective procedure for patients presenting with an immediate drug hypersensitivity reaction (DHR) [1]
This study describes the use of RDDs with chemotherapeutic agents and monoclonal antibodies in patients with delayed DHR
We present the results of 93 RDDs with Chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb) carried out in 11 patients who had suffered delayed, uncomplicated, and non-serious reactions with these drugs
Summary
Rapid drug desensitization (RDD) has shown to be a safe and effective procedure for patients presenting with an immediate drug hypersensitivity reaction (DHR) [1]. Chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb) have been administered by means of this procedure for many years, allowing patients to get their first-line therapies [2,3,4]. Rapid Drug Desensitization in Non-Immediate Reactions the Brigham and Women’s Hospital, which is a three-solution, 12-step protocol, has been widely accepted [8, 9]. Rapid drug desensitization (RDD) allows first-line therapies in patients with immediate drug hypersensitivity reactions (DHR) to chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb). Patients and Method: We retrospectively analyzed the patients referred to the Allergy Department, who had experienced a delayed DHR (> 6 h) related to a ChD or mAb and underwent an RDD protocol. The rate of successful administration of the offending drug and the presence of adverse reactions were evaluated
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