A new rapid protocol for desensitization to chemotherapy agents
Published online: January 18, 2018
Drug allergy usually appears as skin symptoms (rash, itching, swelling), respiratory symptoms (asthma, rhinitis) or anaphylaxis (systemic and severe reaction involving two or more organs) after the administration of a drug. Some of these reactions may be severe and even be life threatening. Allergy to anti-cancer drugs (chemotherapy and monoclonal antibodies (mAb)) can be a cause of discontinuation of the treatment and worsening of the cancer prognosis. Desensitization is an allergological procedure which allows safe reintroduction of a drug in a patient who is sensitized to it. The drug is administered in divided incremental steps following a protocol designed for that purpose. In most cases, desensitization protocols require dilution of the drug in two or more solutions which are given from less to more concentrated.
Recently, in The Journal of Allergy and Clinical Immunology: In Practice, Pérez-Rodríguez et al describe a new, simple, and fast desensitization protocol that uses a single full-strength solution of the drug and allows for reducing the time of administration. This study was conducted at Hospital Universitario La Candelaria in Santa Cruz de Tenerife (Canary Islands, Spain). Ninety patients (60 female and 30 male) who had an allergic reaction to chemotherapy and/or mAb and required continuation of the culprit agent were included. Initial reactions were mild to moderate in 88.2% of subjects. Drugs most frequently implicated were platinum agents (54.0%), taxanes (27.8%) and mAb (12.2%). All patients underwent one or more desensitizations with the study protocol. The drug was administered intravenously, using an infusion pump, beginning at 5 mL/ h and stepping up infusion rate at fifteen minutes intervals. The 90 patients underwent 490 procedures. Target dose was successfully administered in 487 (99.4%). Adverse events were registered in 17.8% of the patients and 5.3% of the procedures. Seventy percent of reactions were mild (only skin symptoms). Respiratory and digestive symptoms were less frequent. No severe adverse events were recorded. Breakthrough reactions were more frequent in patients sensitized to platinum agents, when skin test was positive and in patients who presented severe initial reactions.
In this study, a new, simpler protocol has been shown to be safe and effective for desensitization to chemotherapy drugs in patients who suffered mild to moderate reactions, especially for non-platinum agents. It could contribute to reducing the time and cost of desensitization for this group of patients, although larger studies are needed to validate this observation. Nonetheless, desensitization is a risky procedure and always should be performed by trained personnel.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.