Published Online: February 16, 2016
Patients, oncologists, gastroenterologists, and rheumatologists are at a difficult impasse when drug allergies prevent treatment of serious diseases with first line pharmacotherapeutics . Because hypersensitivity reactions to drugs can be severe and include life-threatening anaphylaxis, re-exposure to the offending medication is often avoided, decreasing the quality of life and life expectancy of sensitized patients.
In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, Sloane et al. investigated the safety, efficacy, costs, and life expectancy of 370 patients undergoing 2177 rapid drug desensitizations (RDD) with a multistep personalized desensitization protocol, which allows allergic patients to tolerate their offending medications without severe side effects, protecting them from anaphylaxis. A gradual increase in the fraction of outpatient desensitizations from 81% to 98% was achieved through risk stratification and of the 2177 desensitizations. Ninety three percent (93%) of desensitizations resulted in no or mild reactions while 7% had moderate to severe reactions. Importantly, such reactions did not preclude the completion of the treatment, and there were no deaths.
Overall healthcare costs in a subgroup of carboplatin allergic patients were not higher than those of non-allergic patients treated with standard infusions. There was a non-significant increase in life expectancy in desensitized patients as compared to non-allergic, non-desensitized controls.
The investigators conclude that RDD is cost effective and safe for drug allergic patients with cancer or chronic inflammatory diseases, allowing them to be treated with optimal pharmacological agents. They advocate that RDD should be the standard of care to maintain patients on first line therapy. Future studies elucidating the mechanisms of RDD should be undertaken to provide better, individualized desensitizations and to assess the effects of pathway targeted pharmacotherapeutics such as anti-IgE on the safety and efficacy of this procedure. Intriguingly, carboplatin allergic patients receiving RDD had a survival advantage, which needs to be explored in further prospective studies.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician