7例对生物制剂和靶向治疗迟发性超敏反应患者的快速药物脱敏:原因、成功和失败。

IF 2.6 3区 医学 Q2 ALLERGY
Tugba Onalan, Fatih Colkesen, Mehmet Emin Gerek, Fatma Arzu Akkus, Recep Evcen, Sevket Arslan
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引用次数: 0

摘要

背景:快速药物脱敏(RDD)通常用于多种药物的即时药物超敏反应(DHR)。在延迟dhr中,常规方法是缓慢脱敏;然而,由于药物特异性或疾病相关因素,可能会出现限制。随着靶向分子药物在迟发性dhr中的作用越来越大,关于RDD在这些情况下疗效的数据仍然很少。目的:本病例系列旨在探讨RDD治疗与靶向治疗相关的延迟性dhr的基本原理和结果。方法:我们分析了2021年1月至2024年4月在某三级大学医院药物过敏门诊就诊的患者的数据。受试者在靶向药物治疗期间出现延迟dhr,随后发生RDD。结果:通过RDD给药的药物包括贝伐单抗、利妥昔单抗、达拉单抗、来那度胺、硼替佐米和卡非佐米。指标反应包括黄斑丘疹(MPE)、嗜酸性粒细胞增多及全身症状的药物反应(DRESS)和急性全身性脓疱病(AGEP)。7例患者中有4例出现延迟突破反应。在所有3例患者中,硼替佐米的RDD治疗均不成功,所有出现严重皮肤不良反应(AGEP和DRESS)的患者均出现延迟反应。结论:认为RDD治疗由靶向治疗引起的迟发性DHRs取得显著成功可能过于乐观。然而,7名患者中有4名,包括1名AGEP患者,能够继续接受治疗。管理晚期疾病患者和延迟DHR带来了显著的挑战。停止使用救命药物对患者生存的风险必须与脱敏的风险进行权衡。皮肤试验的低灵敏度和关键的等待期使决策复杂化。鉴于靶向药物在治疗严重、危及生命的疾病方面的独特贡献,对脱敏的进一步研究是有必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rapid drug desensitization in seven patients with delayed hypersensitivity reactions to biologics and targeted therapies: Reason, successes, and failures.

Backround: Rapid drug desensitization (RDD) is commonly used for immediate drug hypersensitivity reactions (DHR) across various drugs. In delayed DHRs, the conventional approach is slow desensitization; however, limitations may arise due to drug-specific or disease-related factors. With the increasing role of targeted molecular drugs in delayed DHRs, data on the efficacy of RDD in these contexts remain scarce. Objective: This case series aims to explore the rationale and outcomes of RDD in managing delayed DHRs associated with targeted therapies. Methods: We analyzed data from patients referred to a tertiary university hospital's drug allergy outpatient clinic between January 2021 and April 2024. The subjects experienced delayed DHRs during treatment with targeted drugs and, subsequently, underwent RDD. Results: The drugs administered via RDD included bevacizumab, rituximab, daratumumab, lenalidomide, bortezomib, and carfilzomib. The index reactions included maculopapular eruptions (MPE), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). Delayed breakthrough reactions were observed in four of seven patients. RDD with bortezomib was unsuccessful in all three patients, and delayed reactions were observed in all patients with severe cutaneous adverse reactions (AGEP and DRESS). Conclusion: Suggesting significant success of RDD for delayed DHRs induced by targeted therapies may be overly optimistic. Nevertheless, four of seven patients, including one with AGEP, were able to continue their treatment. Managing patients with advanced diseases and delayed DHR poses notable challenges. The risk to patient survival from withholding life-saving medication must be weighed against the risks of desensitization. The low sensitivity of skin tests and the critical waiting period complicate decision-making. Given the unique contribution of targeted agents in the treatment of severe, life-threatening diseases, further research on desensitization is warranted.

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来源期刊
CiteScore
5.70
自引率
35.70%
发文量
106
审稿时长
6-12 weeks
期刊介绍: Allergy & Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists. The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma. Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.
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