Desensitization with Antibiotics

Abstract

Rapid antibiotic desensitization is a type of induction of tolerance by which patients with IgE-mediated allergies to antibiotics may safely receive these drugs. Only patients with type I allergy are candidates for this procedure. Rapid desensitization is intended for clinical situations in which there is an absolute need for an antibiotic and alternate noncross-reacting antibiotics cannot be substituted. Desensitization protocols involve stepwise administration of gradually increasing doses of the antibiotic, starting at a sub-allergenic dose and progressing to the full dose. Successful antibiotic desensitization has been described via the oral, intravenous, intramuscular and inhaled routes. Penicillin desensitization has the longest and largest published body of evidence, but similar regimens have been successfully applied to virtually every other class of antibiotics. Antibiotic desensitization is a relatively safe procedure, and allergic reactions occur in a minority of patients; the vast majority of individuals are able to complete the procedure. Patients undergoing desensitization need to be continually monitored, and medical staff in attendance should be able to rapidly treat potential anaphylaxis. Graded challenge differs from desensitization because the immune response to an antibiotic is not modified. Patients who are unlikely to be allergic to an antibiotic are candidates for graded challenge, whereas desensitization is indicated for those who probably have IgE-mediated allergy.

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

“…These terms have sometimes been used in the context of desensitization procedures. However, we consider them as diagnostic procedures, which are applied to confirm or exclude drug hypersensitivity , and not to induce tolerance to the drug . Desensitization, Hyposensitization, Tolerance induction, Adaptive deactivation …”

Drug Provocation Test as a Diagnostic Approach for Hypersensitivity Reaction to Antituberculosis Drugs: A Report of Two Cases

“…DHR has increased dramatically worldwide. DHR is a subgroup of adverse drug reaction that characterized by reproducible symptoms and/or signs initiated by drug at a dose that is normally tolerated [14,19,20]. Multidrug antituberculosis regimens are associated with various clinical manifestations such as urticaria, generalized pruritus, maculopapular exanthema, lichenoid eruptions, fixed drug eruption, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis [21][22][23].…”

“…Doses are usually administered at 30 min intervals until the usual daily dose is administered or symptoms of a drug reaction occur. Before each dose, the patient should be questioned and examined for symptoms and signs of DHR [13,16,19,24].…”

Tolerance induction in hypersensitivity reactions from drugs: a brief overview

“…However, we consider them as diagnostic procedures, which are applied to confirm or exclude drug hypersensitivity [10,11] and not to induce tolerance to the drug [1,12].…”