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Drug provocation and desensitization to chemotherapy and biologicals

Published online: August 8, 2018

Desensitization is a technique that helps patients with drug allergy tolerate the drug they are allergic to. Chemotherapy and biologicals can be life-saving or life-changing treatments in many patients, so desensitization is extremely beneficial for patients who suffer a reaction to these drugs. Drug provocation testing is a useful but risky technique that allows many patients to reach an unequivocal diagnosis, but it is only performed in centers with expertise in drug allergy.

In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Madrigal-Burgaleta et al report their extensive experience in a 7-year study with patients reacting to chemotherapy and biologicals. Patients were diagnosed using skin testing and blood testing, but they also had the opportunity to undergo drug provocation testing after personalized risk-assessment. The authors used their new short desensitization protocol, which could be less consuming of time and resources.

The authors report data from 1,104 intravenous desensitizations to a number of different drugs including 399 to platins, 395 to taxanes, 178 to biologicals, 77 to cetuximab, and 55 to other drugs. Most reactions during desensitization were mild. Additionally, drug provocation testing helped to rule out allergy in 44% of all referred patients.

The large amount of practical data obtained from this study can help allergists better help their patients in the future by implementing the described diagnostic procedures, and by identifying a wide range of considerations regarding risk, such as predictors of severe reactions, adequate locations for different procedures, and management of special groups of patients.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

A Large Single-Hospital Experience Using Drug Provocation Testing and Rapid Drug Desensitization in Hypersensitivity to Antineoplastic and Biological Agents
By Ricardo Madrigal-Burgaleta, Lorena Bernal-Rubio, Maria Pilar Berges-Gimeno, Laura Victoria Carpio-Escalona, Patricia Gehlhaar, Emilio Alvarez-Cuesta