Standards for practical intravenous rapid drug desensitization &amp; delabeling: A WAO committee statement

Álvarez-Cuesta, Emilio; Madrigal-Burgaleta, Ricardo; Broyles, Ana Dioun; Cuesta‐Herranz, Javier; Guzman-Melendez, María Antonieta; Maciag, Michelle C.; Phillips, Elizabeth; Trubiano, Jason A; Wong, Johnson T.; Ansotegui, Ignacio J.; Ali, FR; Ángel-Pereira, Denisse; Banerji, Aleena; Berges-Gimeno, M P; Bernal-Rubio, Lorena; Brockow, Knut; Villa, Ricardo Cardona; Castells, Mariana; Caubet, Jean-Christoph; Chang, Yoon‐Seok; Ensina, Luis Felipe; Chikhladze, Manana; Chiriac, Anca Mirela; Chung, Wen‐Hung; Ebisawa, Motohiro; Fernandes, Bryan; Garvey, Lene Heise; Gómez, Maximiliano; Vera, Javier Gómez; Díaz, Sandra González; Hong, Deli; Ivancevich, Juan Carlos; Kang, Hye-Ryun; Khan, David A.; Kuruvilla, Merin; Sousa, Jose Ignacio Larco; Latour-Staffeld, Patricia; Liu, Anne Y.; Macy, Eric; Malling, Hans Jorgen; Máspero, Jorge; May, Sara M.; Mayorga, Cristobalina; Park, Miguel A.; Peter, Jonathan; Picard, Matthieu; Rodriguez-Bouza, Tito; Romano, Antonino; Tanno, Luciana Kase; Torres, Marı́a José; Ureña-Tavera, Alicia; Valluzzi, Rocco; Volcheck, Gerald W.; Yamaguchi, Masao

doi:10.1016/j.waojou.2022.100640

Cited by 22 publications

(52 citation statements)

References 283 publications

(830 reference statements)

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“…possible DDS protocols is increasing, as well as the delabeling algorithms and diagnostic tools. 1 Although more rarely, there are some reports in the literature on slow desensitization protocols directed for Type IV reactions, with suspected T-cell involvement. 5,22 In such cases, DDS can be effective in mild/moderate maculopapular exanthemas but it is not currently recommended for severe reactions like SCAR, which include SJS/TEN, 4 DRESS.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

“…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. In children, specially of younger ages this is a matter of special importance, as the patients might not be able to report the initial milder and subjective symptoms of a reaction, like hand, foot, head pruritus, or gastrointestinal symptoms.…”

Section: Risk Assessmentmentioning

confidence: 99%

“…6,59 Other concerns include the lack of specific recommendations regarding the use of premedication for DDS in pediatric age and the high variability between premedication regimens used in different centers. 1 Most of the available large case series describing DDS pretreatment regimens have been conducted in adults. Many authors report using dexamethasone, associated with an H1-antihistamine.…”

Section: Pretreatment Before Dds In Childrenmentioning

confidence: 99%

“…Leukotriene receptor antagonists are used when respiratory symptoms were present in index reactions or as breakthrough symptoms. 1,21,51 Although safer in adults, aspirin can be considered in children when flushing has been reported, and paracetamol can be used to prevent fever, chills, and pain. Isabwe et al published a review of 526 DDS to monoclonal antibodies performed in 104 adult patients.…”

Section: Pretreatment Before Dds In Childrenmentioning

confidence: 99%

See 3 more Smart Citations

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

Cernadas

Vasconcelos

Carneiro‐Leão

2023

Pediatric Allergy Immunology

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Any drug can potentially induce a hypersensitivity reaction. If after the allergological work-up the drug hypersensitivity reaction is confirmed, in most cases, the simple avoidance of the culprit drug and a suggestion of an unrelated alternative is enough.However, there are circumstances where the choice to stop the treatment affects the survival, the safety and/or the quality of life of the patient and the global outcome of the disease in question. When this occurs, drug desensitization can be the answer and should not be viewed as an extravagance, nor the pediatric age should be considered a contraindication. Drug desensitization in children can be safely and successfully performed, having a positive impact on the survival and overall prognosis. In general, the indications for DDS are the same in adults as in children. However, in this age group there are specificities that this paper aimed to describe, reviewing the mechanisms behind drug hypersensitivity and rapid drug desensitization, types of protocols, indications, and contraindications, as well as several technical aspects that are specific to the pediatric age.

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Section: Indications and Contraindicationsmentioning

confidence: 99%

Section: Risk Assessmentmentioning

confidence: 99%

Section: Pretreatment Before Dds In Childrenmentioning

confidence: 99%

Section: Pretreatment Before Dds In Childrenmentioning

confidence: 99%

See 2 more Smart Citations

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

Cernadas

Vasconcelos

Carneiro‐Leão

2023

Pediatric Allergy Immunology

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“…Clinical pharmacist and nurse-led allergist supervised delabelling programs for low-risk index reactors have been shown to be safe, effective and potentially scalable ( 13 , 14 ). Guidelines for penicillin allergy delabelling services in children and adults by non-allergists working in hospital settings, networked with a specialist allergy immunology service for advice and support, have also been published ( 15 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

Delabelling multiple antibiotic allergy: Practical issues

Thong

2023

Front. Allergy

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With the growing incidence of multi-drug resistant organisms, delabelling incorrect antibiotic allergies has become an integral part of antimicrobial stewardship worldwide. For example, around 90% of penicillin allergy labels are found to be inaccurate following a full allergy work-up, which deprive patients the use of effective first-line penicillin antibiotics and increase the risk of antimicrobial resistance with the use of other extended spectrum non-penicillin antimicrobials. Significant numbers of adult and paediatric patients over time are labelled with multiple penicillin and non-penicillin antibiotic allergies often during inappropriate antimicrobial use, resulting in a label of “multiple antibiotic allergy”. In contrast to delabelling penicillin allergy where oral direct provocation tests can be used for low-risk, mild reactions, and sensitivity/specificity/positive and negative predictive values of skin tests have been demonstrated, diagnostic tests for multiple antibiotic allergy often require the use of a combination of in-vivo and in-vitro tests across different antimicrobial classes for evaluation. Shared decision making with patients and informed consent are also needed when prioritising which drugs to delabel first, balancing the risks, benefits of testing vs. interim use of alternative antibiotics. Similar to delabelling penicillin allergy, the cost-effectiveness of delabelling multiple drug allergies is unknown.

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Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings

Sobrino-García,

Muñoz-Bellido,

Moreno-Rodilla

et al. 2024

Int J Clin Pharm

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Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

Cited by 22 publications

References 283 publications

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

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

Delabelling multiple antibiotic allergy: Practical issues

Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings

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