DRUG DESENSITIZATION CHARACTERIZATION: AN INSTITUTIONAL EXPERIENCE

Introduction

Chemotherapy desensitization is utilized following hypersensitivity reactions (HSR) to allow for continued administration of medication following type 1 reactions (type 1), cytokine release reactions (CRR) and mixed reactions (both type 1 and CRR). We describe our institutional experience with desensitization.

Methods

We reviewed the charts of patients with HSR referred to allergy and immunology for desensitization, 18-95 years of age, between 2018 to 2024.

Results

Forty-four patients with immediate HSR and desensitization were reviewed; 10 (23%) males, and 34 females (77%), with a mean age of 62.7 years. Indications for treatment were malignancy (80%), autoimmune disease (18%) and anemia (2%). Index reactions (IR) were type 1 (n= 29, 65.9%), mixed (n=10, 22.7%), and CRR (n= 4, 9.1%). Grade 2 IR severity was most common (30.2%), followed by grade 4 (25.6%) and grade 3 (25.6%). Trigger medications included platinum agents (45.4%), anti-CD20 monoclonal antibodies (mAbs) (38.6%) and taxanes (11.4%). The most common desensitization protocol used was a 12-step (93.2%). Forty-one (93%) patients completed desensitization. Three patients (2 rituximab, 1 ocrelizumab) did not due to reactions during desensitization. Nine breakthrough reactions (BR) occurred, of these, 6 completed the desensitization. No mortality related to desensitization occurred.

Conclusion

Desensitization performed in a facility with anaphylaxis-preparedness is an effective method of administering medications to patients with HSR. All patients undergoing desensitization to platinum agents and taxanes completed desensitization, while 3 patients receiving an anti-CD20 mAb did not due to BR symptoms.