Indications, protocols, and outcomes of drug desensitizations for chemotherapy and monoclonal antibodies in adults and children

Abstract

Advances in the understanding of various malignancies and chronic inflammatory diseases has led to the development of better treatment options for prolonging patient survival and minimizing morbidity. The recognition of "first-line" chemotherapy and monoclonal agents for these conditions has given more urgency to the need to re-administer these drugs in cases of drug hypersensitivity reactions. Therefore, in these cases, not only is desensitization considered when there is no alternative therapy available but also when alternative treatments are considered therapeutically inferior and/or more toxic. In this article, we describe the steps involved in the evaluation of these patients, factors to consider before making a decision to desensitize, the implementation of desensitization protocols, and the outcomes of such procedures.

Keywords: Adult; Allergy; Chemotherapeutic agent; Drug challenge; Drug desensitization; HSR; Hypersensitivity reaction; Hypersensitivity reactions; Monoclonal antibody; Pediatric; Skin testing; mAb.