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Drug Desensitization Update: Key Concepts and Mechanisms

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A Correction to this article was published on 12 February 2024

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Abstract

Purpose of Review

Drug allergy is a worldwide healthcare problem, which prevents the use of first-line therapies and associates with increased morbidity and costs. The availability of new drugs, including biologicals, the extended use of old and new drugs, and the increased longevity of patients have favored sensitization and promoted the appearance of new phenotypes of drug allergy. While penicillin anaphylaxis was the first drug allergy described over 70 years ago, in the last 20 years patients with chemotherapy drugs and targeted therapies reactions have increased around the world.

Recent Findings

Drug-allergic patients are a disadvantaged population which has been addressed with avoidance of culprit drugs, but alternative therapies are not universally available, may be more costly, and may not provide similar therapeutic value. Drug desensitization was initiated to allow patients to be re-exposed safely to drugs which they had reacted.

Summary

Drug desensitization is a novel immunotherapy modality, delivered through multi-step protocols, which takes advantage of immune cells inhibitory mechanisms and addresses acute and delayed reactions. Its use has been expanding in the last 10 years due to unprecedented safety and efficacy. We describe here the mechanisms and principles of drug desensitization, which are applicable to all drug classes and to selected classical and new drug allergy phenotypes.

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Acknowledgements

The figure was created using Adobe Illustrator. L.A.A. would like to extend her thanks to the College of Medicine Research Center, King Saud University, for their support.

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Authors and Affiliations

  1. Division of Allergy and Clinical Immunology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Leila A. Alenazy MD MMSc

  2. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sanaalarab Al Enazy PhD

  3. Division of Allergy and Immunology, Department of Medicine, Drug Allergy and Desensitization Center, Mastocytosis Center Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Mariana Castells MD PhD

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  1. Leila A. Alenazy MD MMSc
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Contributions

L.A.A. conceptualized, designed, and drafted the review manuscript. S.A. played a substantial role in comprehensively reviewing the manuscript and contributed to the design of Figure 1. M.C. critically revised the manuscript for important intellectual content and approved the final version for publication. All authors reviewed and approved the manuscript.

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Correspondence to Mariana Castells MD PhD.

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Leila A. Alenazy declares that she has no conflict of interest. Sanaalarab Al Enazy declares that he has no conflict of interest. Mariana Castells declares that he has no conflict of interest.

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This article is part of the Topical Collection on Immunology of Allergic Diseases

The original online version of this article was revised: This section title “Drug Hypersensitivity Reactions: From Gell and Coombs to an updated approach based on Phenotypes and Endotypes“ in the current published version is not complete, only the "on Phenotypes and Endotypes" is being captured and not the whole title.

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Alenazy, L.A., Al Enazy, S. & Castells, M. Drug Desensitization Update: Key Concepts and Mechanisms. Curr Treat Options Allergy 10, 458–472 (2023). https://doi.org/10.1007/s40521-023-00354-5

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