Rapid drug desensitization for immediate hypersensitivity reactions
- Mariana C Castells, MD, PhD
Mariana C Castells, MD, PhD
- Professor of Medicine
- Harvard Medical School
- Roland Solensky, MD
Roland Solensky, MD
- Oregon State University/Oregon Health and Science University College of Pharmacy
Desensitization is a procedure that alters the immune response to the drug and results in temporary tolerance, allowing the patient with a drug hypersensitivity reaction to receive an uninterrupted course of the medication safely. Once the medication is discontinued or if treatment is interrupted for a sufficient period of time, the patient's hypersensitivity to the medication returns. Desensitization is only safe and effective for certain types of drug allergy. The terms "drug hypersensitivity" and "drug allergy" are used synonymously in this topic review.
Techniques for drug desensitization in patients with immediate hypersensitivity reactions and the proposed mechanisms underlying these techniques will be reviewed here. Desensitizations for reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are not included in this discussion but are discussed elsewhere. (See "Diagnostic challenge and desensitization protocols for NSAID reactions" and "Aspirin-exacerbated respiratory disease: NSAID challenge and desensitization".)
IMMEDIATE DRUG REACTIONS
The World Allergy Organization (WAO) has recommended dividing drug hypersensitivity reactions into two general types [1,2]:
●Immediate/acute reactions – Reactions that begin during the infusion and up to six hours after exposure to the culprit drug.
●Delayed reactions – Reactions that begin after six hours or later after exposure to the culprit drug.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- IMMEDIATE DRUG REACTIONS
- Types of immediate reactions
- - IgE-mediated
- - Non-IgE-mediated
- OTHER TYPES OF DRUG ALLERGY
- POSSIBLE MECHANISMS OF DESENSITIZATION
- PATIENT SELECTION
- Risk stratification
- Setting and staffing
- - Incidence of breakthrough symptoms
- - Rare immunologic complications
- Informed consent
- TECHNICAL ASPECTS OF DESENSITIZATION
- Overview of the technique
- Route of administration
- Dose increase and time interval for each step
- Patient preparation
- - For IgE-mediated reactions
- - For non-IgE-mediated reactions
- Oral protocols
- Standardized intravenous protocol
- - Time required
- Protocol for patients with past severe reactions
- Administering the protocol
- - Management of symptoms during desensitization
- Adjusting the protocol
- - When to abort a desensitization
- Maintaining the desensitized state
- COUNSELING THE PATIENT AFTER DESENSITIZATION
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS