General considerations on rapid desensitization for drug hypersensitivity – a consensus statement

Cernadas, J.R.; Brockow, Knut; Romano, Antonino; Aberer, Werner; Torres, Marı́a José; Bircher, Andreas J.; Campi, Paolo; Sánz, M L; Castells, Mariana; Demoly, Pascal; Pichler, Werner J.

doi:10.1111/j.1398-9995.2010.02441.x

Cited by 311 publications

(325 citation statements)

References 86 publications

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“…Before desensitization is undertaken, a careful evaluation of the risks and benefits must be considered and discussed with the patient. Indications and contraindications concerning the desensitization procedure are outlined in a position paper by the ENDA interest group [207].…”

Section: Desensitizationmentioning

confidence: 99%

“…Drug desensitization requires considerable experience and specialist knowledge and should only be undertaken in specialist centres. Full resuscitation facilities, expertise in the acute management of anaphylaxis and access to an intensive care unit are essential [207].…”

Section: Desensitizationmentioning

confidence: 99%

“…The dose is increased by half-log or doubling increments at 15-min intervals for IV desensitization or at 45-60 min for oral desensitization until the therapeutic dose is achieved [207] (Appendix , Table A3). Standard protocols for IV desensitization have been published and can be adapted for a range of drugs [218][219][220].…”

Section: Desensitizationmentioning

confidence: 99%

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Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Desensitizationmentioning

confidence: 99%

Section: Desensitizationmentioning

confidence: 99%

See 1 more Smart Citation

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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“…Desensitisation is the induction of a state of tolerance in a patient hypersensitised to an allergen by increasing sub-therapeutic doses. Classically used for IgE-mediated reactions (hypersensitivity type I), it has been used for drugs nonIgE-mediated hypersensitivity reactions (Cernadas et al 2010). Despite extensive experience (Castells et al 2008), the underlying molecular and cellular basis is poorly understood but may involve depletion of allergic mediators, modification of signal transduction, generation of allergenspecific T-regulatory cells inducing of a tolerant state in peripheral T cells or 'blocking' IgG antibodies (Cernadas et al 2010;Wachholz and Durham 2003;Akdis and Akdis 2007).…”

Section: Discussionmentioning

confidence: 99%

Successful Desensitisation in a Patient with CRIM-Positive Infantile-Onset Pompe Disease

et al. 2013

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Pompe disease (PD) is a severe life-threatening disease in which enzyme replacement therapy (ERT) with alglucosidase alfa is the only treatment available. Recently it has been shown that antibody formation may have a significant adverse effect on response to ERT. We report a cross-reactive immunologic material (CRIM)-positive PD infant who developed severe infusion-associated reactions (IARs) after 15 uneventful months of ERT. We successfully got the child to tolerate the ERT by a desensitisation protocol. We diluted the total amount of standard alglucosidase alfa infusion (20 mg/kg/dose) to 1/100 (0.2 mg/kg/ dose). The original infusion rates were maintained. We doubled this dose every week. No premedication was given. In 8 weeks, we reached the standard dose without any IAR. No further reactions have been observed during 6 months of follow-up. Importantly, clinical deterioration that was observed during the period of reduced enzyme delivery has almost completely reversed. We conclude that this protocol was effective in our patient, while being safe and easy to follow, and may be suitable in selected cases.

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“…5 In general, it is preferable that the dose increase for each step of desensitization is no more than a 2-fold increase. 7 Our protocol not only adheres to this concept but also addresses a new concept of adjusting the rate of infusion during desensitization for the patient's weight, which is particularly helpful in younger patients. This differs from the standard adult 12-step desensitization protocol mostly because the infusion rate of the last step is lower related to the lower weight of pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Rituximab Desensitization in Pediatric Patients: Results of a Case Series

Dilley

Lee

Platt

et al. 2016

Pediatric Allergy, Immunology, and Pulmonology

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Rituximab is a monoclonal antibody (mAb) primarily used to treat oncologic and autoinflammatory conditions. Although hypersensitivity reactions (HSRs) and desensitization protocols to mAbs have been well described in adults, the experience in the pediatric population is very limited. We sought to determine the safety and efficacy of desensitization to rituximab in the pediatric population at our institution. We retrospectively reviewed the experience with HSRs and desensitization to rituximab during a 5-year period in our tertiary care pediatric center, including reaction evaluation, premedication regimens, and desensitization procedures and protocols. A total of 17 desensitizations to rituximab were performed in three patients. A 14-year-old patient underwent successful desensitization to rituximab using a published adult protocol without incident. Two younger patients (ages 7 years and 23 months) experienced significant reactions during initial desensitization attempts. Therefore, we designed a modified desensitization protocol to rituximab, with particular attention to the rate of infusion as mg/kg/h. This new patient weight-based protocol was successfully used in a total of 13 desensitizations in these two patients. Desensitization to rituximab was a safe and effective procedure in our pediatric population. We present a new patient weight-based desensitization protocol for pediatric patients who develop HSRs to rituximab, with particular usefulness for younger pediatric patients and potential utility in pediatric patients with HSRs to other mAbs.

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General considerations on rapid desensitization for drug hypersensitivity – a consensus statement

Cited by 311 publications

References 86 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Successful Desensitisation in a Patient with CRIM-Positive Infantile-Onset Pompe Disease

Rituximab Desensitization in Pediatric Patients: Results of a Case Series

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