Skip to main content

Advertisement

SpringerLink
Log in

Update on Desensitization

  • Drug Allergy (L Mayorga, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Abstract

Purpose of review

Rapid drug desensitization (RDD) is a high-risk protocol that allows patients with hypersensitivity reactions to remain on first-line therapy for their underlying conditions through titration of dose increments and infusion rates. The aim of this paper is to review the most recent desensitization protocols available for drugs that are commonly used in clinical practice settings and to provide algorithms for their appropriate usage.

Recent findings

RDD protocols involve identification of phenotypes and endotypes during the initial reaction, risk stratification, skin testing, and specific biomarkers. Patients’ protocols are personalized and can increase life expectancy and quality of life.

Summary

The benefits of RDD largely outweigh the risks. All patients with hypersensitivity reactions should be evaluated for desensitization, to avoid alternatives treatments that may be less effective or intolerant patients presenting with SCARS (DRESS/SJS/TEN) are not candidates for desensitization since the mechanism of the reactions are poorly understood.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Castells M. Drug Hypersensitivity and anaphylaxis in cancer and chronic inflammatory diseases: the role of desensitizations. Front Immunol. 2017;8:1472.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. •• Castells MC. Drug allergy: phenotypes, endotypes, and biomarkers. J Allergy Clin Immunol Pract. 2017;5(3):626–7 This study classifies the different phenotypes and endotypes of drug hypersensitivity reactions, allowing the better understanding of the underlying mechanisms of those reactions to define the treatment algorithms and desensitization protocols.

    Article  PubMed  Google Scholar 

  3. Simons FE, Ardusso LR, Bilo MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. 2011;127(3):587–93 e1-22.

    Article  Google Scholar 

  4. Macy E, Ngor EW. Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin. J Allergy Clin Immunol Pract. 2013;1(3):258–63.

    Article  PubMed  Google Scholar 

  5. King EA, Challa S, Curtin P, Bielory L. Penicillin skin testing in hospitalized patients with β-lactam allergies: effect on antibiotic selection and cost. Ann Allergy Asthma Immunol. 2016;117(1):67–71.

    Article  CAS  PubMed  Google Scholar 

  6. Empedrad R, Darter AL, Earl HS, Gruchalla RS. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol. 2003;112(3):629–30.

    Article  CAS  PubMed  Google Scholar 

  7. O’Donovan WJ, Klorfajn I. Sensitivity to penicillin:anaphylaxis and desensitization. Lancet. 1946;248:444–6.

    Article  Google Scholar 

  8. Wendel GD Jr, Stark BJ, Jamison RB, Molina RD, Sullivan TJ. Penicillin allergy and desensitization in serious infections during pregnancy. N Engl J Med. 1985;312(19):1229–32.

    Article  PubMed  Google Scholar 

  9. Garcia JFB, Aun MV, Garro LS, Kalil, et al. Risk stratification for penicillin desensitization in allergic pregnant women with syphilis. J Allergy Clin Immunol. 2017;139(2):AB31.

    Article  Google Scholar 

  10. Giavina-Bianchi P, Caiado J, Picard M, Pur Ozyigit L, Mezzano V, Castells M, et al. Rapid desensitization to chemotherapy and monoclonal antibodies is effective and safe. Allergy. 2013;68(11):1482–4.

    Article  CAS  PubMed  Google Scholar 

  11. Burrows JA, Toon M, Bell SC. Antibiotic desensitization in adults with cystic fibrosis. Respirology. 2003;8(3):359–64.

    Article  PubMed  Google Scholar 

  12. Lee CW, Matulonis UA, Castells MC. Rapid inpatient/outpatient desensitization for chemotherapy hypersensitivity: standard protocol effective in 57 patients for 255 courses. Gynecol Oncol. 2005;99(2):393–9.

    Article  PubMed  Google Scholar 

  13. Feldweg AM, Lee CW, Matulonis UA, Castells M. Rapid desensitization for hypersensitivity reactions to paclitaxel and docetaxel: a new standard protocol used in 77 successful treatments. Gynecol Oncol. 2005;96(3):824–9.

    Article  CAS  PubMed  Google Scholar 

  14. Castells M. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol. 2008;122:574–80.

    Article  CAS  PubMed  Google Scholar 

  15. Legere HJ 3rd, Palis RI, Rodriguez Bouza T, Uluer AZ, Castells MC. A safe protocol for rapid desensitization in patients with cystic fibrosis and antibiotic hypersensitivity. J Cyst Fibros. 2009;8(6):418–24.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Absar N, Daneshvar H, Beall G. Desensitization to trimethoprim/sulfamethoxazole in HIV-infected patients. J Allergy Clin Immunol. 1994;93(6):1001–5.

    Article  CAS  PubMed  Google Scholar 

  17. Caumes E, Guermonprez G, Lecomte C, Katlama C, Bricaire F. Efficacy and safety of desensitization with sulfamethoxazole and trimethoprim in 48 previously hypersensitive patients infected with human immunodeficiency virus. Arch Dermatol. 1997;133(4):465–9.

    Article  CAS  PubMed  Google Scholar 

  18. Kalanadhabhatta V, Muppidi D, Sahni H, Robles A, Kramer M. Successful oral desensitization to trimethoprim-sulfamethoxazole in acquired immune deficiency syndrome. Ann Allergy Asthma Immunol. 1996;77(5):394–400.

    Article  CAS  PubMed  Google Scholar 

  19. Gluckstein D, Ruskin J. Rapid oral desensitization to trimethoprim-sulfamethoxazole (TMP-SMZ): use in prophylaxis for Pneumocystis carinii pneumonia in patients with AIDS who were previously intolerant to TMP-SMZ. Clin Infect Dis. 1995;20(4):849–53.

    Article  CAS  PubMed  Google Scholar 

  20. Cortese LM, Soucy DM, Endy TP. Trimethoprim/sulfamethoxazole desensitization. Ann Pharmacother. 1996;30(2):184–6.

    Article  CAS  PubMed  Google Scholar 

  21. Gompels MM, Simpson N, Snow M, Spickett G, Ong E. Desensitization to co-trimoxazole (trimethoprim-sulphamethoxazole) in HIV-infected patients: is patch testing a useful predictor of reaction? J Infect. 1999;38(2):111–5.

    Article  CAS  PubMed  Google Scholar 

  22. Pyle RC, Butterfield JH, Volcheck GW, Podjasek JC, Rank MA, Li JT, et al. Successful outpatient graded administration of trimethoprim-sulfamethoxazole in patients without HIV and with a history of sulfonamide adverse drug reaction. J Allergy Clin Immunol Pract. 2014;2(1):52–8.

    Article  PubMed  Google Scholar 

  23. Bray F, Ferlay J, Soerjomataram I, Siegel LR, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;8(6):394–424.

    Article  Google Scholar 

  24. • Sloane D, Govindarajulu U, Harrow-Mortelliti J, Barry W, Hsu FI, Hong D, et al. Safety, costs, and efficacy of rapid drug desensitizations to chemotherapy and monoclonal antibodies. J Allergy Clin Immunol Pract. 2016. This paper evaluates the efficacy and the cost effectiveness of desensitization and its impact on patient’s overall survival rates and quality of life.;4:497–504.

    Article  PubMed  Google Scholar 

  25. Caiado J, Venemalm L, Pereira-Santos MC, Costa L, Barbosa MP, Castells M. Carboplatin-, oxaliplatin-, and cisplatin-specific IgE: cross-reactivity and value in the diagnosis of carboplatin and oxaliplatin allergy. J Allergy Clin Immunol Pract. 2013;1(5):494–500.

    Article  PubMed  Google Scholar 

  26. Gadducci A, Tana R, Teti G, Zanca G, Fanucchi A, Genazzani AR. Analysis of the pattern of hypersensitivity reactions in patients receiving carboplatin retreatment for recurrent ovarian cancer. Int J Gynecol Cancer. 2008;18(4):615–20.

    Article  CAS  PubMed  Google Scholar 

  27. Castells MC, Tennant NM, Sloane DE, Hsu FI, Barrett NA, Hong DI, et al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol. 2008;122(3):574–80.

    Article  CAS  PubMed  Google Scholar 

  28. Giavina-Bianchi P, Galvao VR, Picard M, Caiado J, Castells MC. Basophil activation test is a relevant biomarker of the outcome of rapid desensitization in platinum compounds-allergy. J Allergy Clin Immunol Pract. 2017;5(3):728–36.

    Article  PubMed  Google Scholar 

  29. Wong JT, Ling M, Patil S, Banerji A, Long A. Oxaliplatin hypersensitivity: evaluation, implications of skin testing, and desensitization. J Allergy Clin Immunol Pract. 2014;2(1):40–5.

    Article  PubMed  Google Scholar 

  30. Valent P, Akin C, Bonadonna P, Hartmann K, Broesby-Olsen S, Brockow K, et al. Mast cell activation syndrome: Importance of consensus criteria and call for research. J Allergy Clin Immunol. 2018;142(3):1008–10.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Caiado J, Castells M. Presentation and diagnosis of hypersensitivity to platinum drugs. Curr Allergy Asthma Rep. 2015;15(4):15.

    Article  PubMed  CAS  Google Scholar 

  32. Maindrault-Goebel F, Andre T, Tournigand C, Louvet C, Perez-Staub N, Zeghib N, et al. Allergic-type reactions to oxaliplatin: retrospective analysis of 42 patients. Eur J Cancer. 2005;41(15):2262–7.

    Article  CAS  PubMed  Google Scholar 

  33. • Isabwe GAC, Garcia Neuer M, de Las Vecillas Sanchez L, Lynch DM, Marquis K, Castells M. Hypersensitivity reactions to therapeutic monoclonal antibodies: phenotypes and endotypes. J Allergy Clin Immunol. 2018;142(1):159–70 e2 This paper reviews hypersensitivity reactions to the main monoclonal antibodies used in clinical practice and desensitization protocols.

    Article  CAS  PubMed  Google Scholar 

  34. Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J. Paclitaxel-associated hypersensitivity reactions: experience of the gynecologic oncology program of the Cleveland Clinic Cancer Center. J Clin Oncol. 2000;18(1):102–5.

    Article  CAS  PubMed  Google Scholar 

  35. Kwon JS, Elit L, Finn M, Hirte H, Mazurka J, Moens F, et al. A comparison of two prophylactic regimens for hypersensitivity reactions to paclitaxel. Gynecol Oncol. 2002;84(3):420–5.

    Article  CAS  PubMed  Google Scholar 

  36. Syrigou E, Makrilia N, Vassias A, Nikolaidis I, Xyla V, Manolopoulos L, et al. Administration of cisplatin in three patients with carboplatin hypersensitivity: is skin testing useful? Anti-Cancer Drugs. 2010;21(3):333–8.

    Article  CAS  PubMed  Google Scholar 

  37. Syrigou E, Dannos I, Kotteas E, Makrilia N, Tourkantonis I, Dilana K, et al. Hypersensitivity reactions to docetaxel: retrospective evaluation and development of a desensitization protocol. Int Arch Allergy Immunol. 2011;156(3):320–4.

    Article  CAS  PubMed  Google Scholar 

  38. Vasey PA, Jayson GC, Gordon A, Gabra H, Coleman R, Atkinson R, et al. Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma. J Natl Cancer Inst. 2004;96(22):1682–91.

    Article  CAS  PubMed  Google Scholar 

  39. Picard M, Galvao VR. Current Knowledge and management of hypersensitivity reactions to monoclonal antibodies. J Allergy Clin Immunol Pract. 2017;5(3):600–9.

    Article  PubMed  Google Scholar 

  40. Picard M, Giavina-Bianchi P, Mezzano V, Castells M. Expanding spectrum of mast cell activation disorders: monoclonal and idiopathic mast cell activation syndromes. Clin Ther. 2013;35(5):548–62.

    Article  CAS  PubMed  Google Scholar 

  41. Picard M, Pur L, Caiado J, Giavina-Bianchi P, Galvao VR, Berlin ST, et al. Risk stratification and skin testing to guide re-exposure in taxane-induced hypersensitivity reactions. J Allergy Clin Immunol. 2016;137(4):1154–64 e12.

    Article  PubMed  CAS  Google Scholar 

  42. Yang BC, Castells MC. Rituximab hypersensitivity and desensitization: a personalized approach to treat cancer and connective tissue diseases. Ann Allergy Asthma Immunol. 2019;123:11–5.

    Article  PubMed  Google Scholar 

  43. Labella M, Garcia-Neuer M, Castells M. Application of precision medicine to the treatment of anaphylaxis. Curr Opin Allergy Clin Immunol. 2018;18(3):190–7.

    Article  CAS  PubMed  Google Scholar 

  44. Pagani M, Bavbek S, Dursun AB, Bonadonna P, Caralli M, Cernadas J, et al. Role of skin tests in the diagnosis of immediate hypersensitivity reactions to taxanes: results of a multicenter study. J Allergy Clin Immunol Pract. 2019;7(3):990–7.

    Article  PubMed  Google Scholar 

  45. Foer D, Buchheit KM, Gargiulo AR, Lynch DM, Castells M, Wickner PG. Progestogen hypersensitivity in 24 cases: diagnosis, management, and proposed renaming and classification. J Allergy Clin Immunol Pract. 2016;4(4):723–9.

    Article  PubMed  Google Scholar 

  46. Prieto-Garcia A, Sloane D, Gargiulo AR, Feldweg AM, Castells M. Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization. Fertil Steril. 201 ;95(3):1121.e9-13.

    Article  Google Scholar 

  47. Santos RB, Galvao VR. Monoclonal antibodies hypersensitivity: prevalence and management. Immunol Allergy Clin N Am. 2017;37(4):695–711.

    Article  Google Scholar 

  48. Maurer M, Altrichter S, Bieber T, Biedermann T, Brautigam M, Seyfried S, et al. Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase. J Allergy Clin Immunol. 2011;128(1):202–9 e5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Building of Transformative Medicine, BWH, Harvard Medical School, 60 Fenwood Road, 5002N, Boston, MA, 02115, USA

    Lucila Campos MD, Sahar A. Hamadi BS, Donna-Marie Lynch NP, Kathleen Marquis Pharm D, PhD & Mariana C. Castells MD, PhD

  2. Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, SP, Brazil

    Lucila Campos MD

Authors
  1. Lucila Campos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sahar A. Hamadi BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donna-Marie Lynch NP
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathleen Marquis Pharm D, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mariana C. Castells MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mariana C. Castells MD, PhD.

Ethics declarations

Conflict of interest

Lucila Campos declares that she has no conflicts of interest. Sahar Hamadi declares that she has no conflicts of interest. Donna-Marie Lynch declares that she has no conflicts of interest. Kathleen Marquis declares that she has no conflicts of interest. Mariana Castells declares that she has no conflicts of interest

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Drug Allergy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Campos, L., Hamadi, S.A., Lynch, DM. et al. Update on Desensitization. Curr Treat Options Allergy 6, 519–537 (2019). https://doi.org/10.1007/s40521-019-00231-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-019-00231-0

Keywords

Search

Navigation