Desensitization to drugs in children

Abstract

Better knowledge and understanding about drug desensitization is required in the pediatric population, since there is little literature available about it and the most pediatric desensitization protocols have been adapted from adult instructions. Aiming to soften this issue and foster the future studies, this article presents a recent review about mechanisms of desensitization, diagnostic tools, and up to date management of drug hypersensitivity reactions in children. Bringing up an overview of pediatric hypersensitivity reactions to chemotherapy, biologic agents, antibiotics, nonsteroidal anti-inflammatory drugs, and vaccines.

The Impact of Processing and Extraction Methods on the Allergenicity of Targeted Protein Quantification as Well as Bioactive Peptides Derived from Egg

“…This finding underscores the importance of investigating all major egg allergens, not just those in the EW. Unfortunately, the current approach to managing egg allergies is strict avoidance, which is difficult because eggs are present in many processed foods and medicines, such as vaccines [ 209 , 210 ]. Additionally, avoiding eggs can lead to nutritional deficiencies since they are a valuable source of essential vitamins, proteins, and fatty acids [ 211 ].…”

“…Since an adverse immunological reaction to egg proteins causes atopic dermatitis and eosinophilic esophagitis, it follows that egg allergy is an IgE antibody-mediated allergy [ 225 , 226 ]. Egg proteins’ ability to provoke an immune response is reflected in their stability in the face of heat and enzymatic digestion [ 206 , 207 , 208 , 209 , 210 , 211 , 212 , 213 , 214 , 215 , 216 , 217 , 218 , 219 , 220 , 221 , 222 , 223 , 224 , 225 , 226 , 227 ]. While both egg components contain proteins that can trigger an allergic reaction, the allergenic potential of EW proteins is greater than that of EY proteins.…”

Desensitization in children allergic to drugs: Indications, protocols, and limits

“…In immediate reactions, mast cell activation and inflammatory mediator release are inhibited during desensitization. 9,13,17 Some possible mechanisms to explain the temporary tolerance to the drug include:…”

“…An informed consent signed by parents and/or tutors is recommended before any procedure. 6,17,21,30 Usually, the reactions occurring during DDS are milder than the index reaction and there are no reported deaths associated with these procedures in the literature, when performed by experienced allergists. 1 However, caution and close surveillance by well-trained specialists is mandatory in all cases, with continuous monitoring of the child.…”

“…The efficacy of DDS was known way before the underlying mechanisms that are still not fully established and understood, especially in delayed reactions. In immediate reactions, mast cell activation and inflammatory mediator release are inhibited during desensitization 9,13,17 . Some possible mechanisms to explain the temporary tolerance to the drug include: Rearrangement of sensitized mast cell/basophils membranes, due to exposition to low doses of antigen, preventing the internalization of the antigen‐receptor complex 18 Generation of immunoglobulin G blocking antibodies that neutralize drug epitopes 13 Blockage of calcium mobilization 19 Altered cellular signaling in mast cells and basophils (e.g., reduction of syk kinase) 20 Increase of regulatory cytokines, mainly IL‐10 and production of T regulatory cells 13 …”