Drug desensitization is the induction of temporary clinical unresponsiveness to drug antigens to which patients have presented severe hypersensitivity reactions (HSR). Rapid desensitization in patients suffering immediate hypersensitivity reactions with chemotherapeutic agents and monoclonal antibodies have been widely described and have shown to be successful. Non-immediate hypersensitivity reactions with other drugs have usually required desensitization with several days’ protocols to achieve total doses.
Methods:
Thirty-eight desensitization procedures were performed in 5 patients with a 12-13 step, 6-hour protocol. All patients had developed a delayed maculopapular rash with the use of chemotherapeutic and/or biological agents. Three patients were pretreated with corticosteroids, paracetamol and antihistamines before each desensitization procedure.
Results:
All the 38 desensitizations undertaken were successfully completed (25 with Temozolamide, 4 with Bendamustine, 4 with Rituximab and 5 with Infliximab). We observed HSR during 8 (21%) of desensitizations, including 5 inmediate exantema and 3 delayed local macular exantema. Two patients were treated with corticosteroids and anti-histamines after the desensitization protocol to avoid more delayed HSR.
Conclusions:
Rapid desensitization protocols are safe and effective in getting over delayed HSR to chemotherapeutic and monoclonal antibodies and allow patients with severe diseases to continue their treatment.