General considerations on rapid desensitization for drug hypersensitivity – a consensus statement

Authors

  • J. R. Cernadas,

    1. Department of Allergy and Clinical Immunology, Medical University, H. S. João, Porto, Portugal
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    • These authors contributed equally to this work.

    • Members of the EAACI drug desensitization task force.

  • K. Brockow,

    1. Department of Dermatology und Allergology Biederstein, Division Environmental Dermatology and Allergology Helmholtz Zentrum Munchen/TUM, Technical University Munich, Munich, Germany
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    • These authors contributed equally to this work.

    • Members of the EAACI drug desensitization task force.

  • A. Romano,

    1. Allergy Unit, C.I. Columbus, Rome and IRCCS Oasi Maria S.S., Troina, Italy
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    • These authors contributed equally to this work.

    • Members of the EAACI drug desensitization task force.

  • W. Aberer,

    1. Department of Dermatology, Medical University of Graz, Graz, Austria
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    • Members of the EAACI drug desensitization task force.

  • M. J. Torres,

    1. Research Unit for Allergic Diseases, Allergy Service, Carlos Haya Hospital, Malaga, Spain
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    • Members of the EAACI drug desensitization task force.

  • A. Bircher,

    1. Allergy Unit, Department of Dermatology, University Hospital, Basel, Switzerland
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    • Members of the EAACI drug desensitization task force.

  • P. Campi,

    1. Allergy Clinic, Azienda Sanitaria di Firenze, Florence, Italy
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    • Members of the EAACI drug desensitization task force.

  • M. L. Sanz,

    1. Department of Allergology and Clinical Immunology, University Clinic, University of Navarra, Pamplona, Spain
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    • Members of the EAACI drug desensitization task force.

  • M. Castells,

    1. Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, and the Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
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  • P. Demoly,

    1. Exploration des Allergies, Maladies Respiratoires, INSERM U657, Hopital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
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    • Members of the EAACI drug desensitization task force.

  • W. J. Pichler,

    1. Clinic for Rheumatology and Clinical Immunology/Allergology, Inselspital, Bern, Switzerland
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    • Members of the EAACI drug desensitization task force.

  • for the European Network of Drug Allergy and the EAACI interest group on drug hypersensitivity

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    • The paper was first drafted by Josefina Rodrigues Cernadas, Portugal, and revised by Knut Brockow, Germany and Antonino Romano, Italy. Important input was added by Werner Aberer, Austria, Maria José Torres, Spain, Andreas Bircher, Switzerland, Paolo Campi, Italy, Maria Luisa Sanz, Spain, Mariana Castells, USA, Pascal Demoly, France, and Werner Pichler, Switzerland.


  • Edited by: Hans-Uwe Simon

J. R. Cernadas, Department of Allergy and Clinical Immunology, Medical University- H. S. João, Alameda Hernani Monteiro, 4000 Porto, Portugal.
Tel.: +35 122 913650262
Fax: +35 122 2008892
E-mail: josefinacernadas@gmail.com

Abstract

To cite this article: Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, Campi P, Sanz ML, Castells M, Demoly P, Pichler WJ, for the European Network of Drug Allergy and the EAACI interest group on drug hypersensitivity. General considerations on rapid desensitization for drug hypersensitivity – a consensus statement. Allergy 2010; 65: 1357–1366.

Abstract

Drug hypersensitivity reactions can occur with most drugs, are unpredictable, may affect any organ or system, and range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. However, for certain patients, the particular drug may be essential for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance of a compound responsible for a hypersensitivity reaction. It is performed by administering increasing doses of the medication concerned over a short period of time (from several hours to a few days) until the total cumulative therapeutic dose is achieved and tolerated. It is a high-risk procedure used only in patients in whom alternatives are less effective or not available after a positive risk/benefit analysis. Desensitization protocols have been developed and are used in patients with allergic reactions to antibiotics (mainly penicillin), insulins, sulfonamides, chemotherapeutic and biologic agents, and many other drugs. Desensitization is mainly performed in IgE-mediated reactions, but also in reactions where drug-specific IgE have not been demonstrated. Desensitization induces a temporary tolerant state, which can only be maintained by continuous administration of the medication. Thus, for treatments like chemotherapy, which have an average interval of 4 weeks between cycles, the procedure must be repeated for every new course. In this paper, some background information on rapid desensitization procedures is provided. We define the drugs and drug reactions indicated for such procedures, describe the possible mechanism of action, and discuss the indications and contraindications. The data should serve as background information for a database (accessible via the EAACI-homepage) with standardized protocols for rapid desensitization for antibiotics, chemotherapeutic agents, monoclonal antibodies/fusion proteins, and other drugs.

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