Update on Desensitization

Campos, Lucila de Sousa; Hamadi, Sahar; Lynch, Donna‐Marie; Marquis, Kathleen A.; Castells, Mariana

doi:10.1007/s40521-019-00231-0

Cited by 6 publications

(4 citation statements)

References 48 publications

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“…Endotypes of anaphylaxis include direct mast cell and basophil activation through an IgE or non-IgE-mediated mechanism, complement activation, cytokine release and mixed reactions. [25][26][27] But unlike HSR that occur with other chemotherapeutic agents, reactions to taxanes generally occur on first exposure and a smaller percentage during second exposure, suggesting that the underlying mechanism occurs by direct activation of mast cells and/or basophils but leaving the possibility that patients may have been primarily sensitized through similar epitopes 28 with crossreactivity due to previous exposure to pollens, 27,29,30 food allergens or with an underlying mechanism to the HSR not mediated by IgE.…”

Section: Discussionmentioning

confidence: 99%

Atopy, allergen sensitization and development of hypersensitivity reactions to paclitaxel

González-Díaz

Canel-Paredes

Macías-Weinmann

et al. 2022

J Oncol Pharm Pract

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Background Paclitaxel is a chemotherapeutic agent used in the treatment of multiple types of malignant tumors which was discovered from the Taxus brevofilia tree. In some patients, anaphylaxis develops during the first exposure to paclitaxel, suggesting that primary sensitization may have occurred through hidden or unidentified allergens that produce cross-reactivity. Skin testing may be useful in identifying sensitization to these allergens. Atopy has also been reported in patients with hypersensitivity reactions (HSR) to paclitaxel. The aim of this study is to evaluate the association between atopy and sensitization to allergens with the development of immediate HSR to paclitaxel. Methods Skin prick tests (SPT) for environmental and food allergens were applied to 76 patients recently diagnosed with cancer. A SPT to paclitaxel was applied and if negative, an intradermal test was performed. After paclitaxel's infusion, the development of immediate HSR was observed. Results Of 76 skin tests, 43% of patients had allergen sensitization and 57% did not. HSR occurred in 12.1% and 11.6% of each group, respectively. Five percent of patients tested positive to paclitaxel and only one had an immediate HSR. Eighty-nine percent of patients who developed an HSR had a family or personal history of atopy. Conclusions Sensitization to environmental or food allergens does not appear to be a risk factor for the development of immediate HSR to paclitaxel, suggesting that there are other non-IgE-mediated immunologic mechanisms responsible for their development, however, a personal and family history of atopy increases 8x the risk of developing anaphylaxis.

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Section: Discussionmentioning

confidence: 99%

Atopy, allergen sensitization and development of hypersensitivity reactions to paclitaxel

González-Díaz

Canel-Paredes

Macías-Weinmann

et al. 2022

J Oncol Pharm Pract

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“…This is due to increased use of high dose intravenous antibiotics, frequent antibiotic courses and improving survival in patients with CF ( 4 ). Drug desensitization is a procedure which alters the immune response to the drug and results in temporary tolerance ( 5 – 7 ). The exact mechanisms which allowed that tolerance are not fully elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, many routes seem to be feasible. Starting dose, number of steps and dosing frequency differ between available protocols ( 5 – 7 ). A 12-step standardized intravenous (IV) protocol has been developed and used successfully for immediate hypersensitivity reactions to a variety of drugs ( 5 ) In fact, more rush or more prolonged protocols can be successfully used.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Maintenance of Desensitization to Nebulized Colomycin Over 10 Years

et al. 2021

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Drug desensitization can be achieved successfully by gradual drug dose increases in different protocols. Most protocols are designed to obtain temporal tolerance. The data on long-term maintenance of drug tolerance is scarce. Based on an IgE-mediated colomycin allergy we describe the maintenance of drug tolerance to nebulized drug for the period of 10 years in a 15-year-old cystic fibrosis patient, proceeded by successful rush intravenous desensitization protocol. The mechanism of drug tolerance is largely speculative; however, long-term maintenance of it seems achievable by continuous local drug application.

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“…Patients with type II reactions, serum sickness, severe cutaneous adverse reactions, and organ-specific toxicities as found with CPIs, are not candidates for DD because of the risk of potentially fatal reactions on reexposure to even small amounts of the culprit medication (Table 2). 44 Personalized premedication is based on the symptoms experienced by the patient at the initial reaction, and it is administered 30 minutes before the initiation of DD. 45,46 Specific algorithms for monoclonal antibodies based on endotypes, phenotypes, and biomarkers guide us to choose the suitable protocol.…”

Section: Other In Vitro Biomarkersmentioning

confidence: 99%

Hypersensitivity reactions and anaphylaxis to checkpoint inhibitor–monoclonal antibodies and desensitization

Labella

Castells

2021

Annals of Allergy, Asthma & Immunology

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To review type 1 hypersensitivity reactions and anaphylaxis to checkpoint inhibitor−monoclonal antibodies and its management with drug desensitization. Data Sources: English-language literature on MEDLINE regarding hypersensitivity, anaphylaxis, and checkpoint inhibitor−monoclonal antibodies. Study Selections: References were selected based on relevance, novelty, robustness, and applicability. Results: There are well-known tissue toxicities associated to checkpoint inhibitors, but hypersensitivity reactions and anaphylaxis have been underreported. The presentation of these reactions is based on clinical phenotypes with underlying endotypes identified by specific biomarkers. Drug desensitizations have been successfully applied to checkpoint inhibitor drugs to allow patients with cancer to receive first-line therapies. This review provides current best practices for the recognition and diagnosis of hypersensitivity reactions and anaphylaxis to checkpoint inhibitors and their management using drug desensitization. Conclusion: Hypersensitivity reactions and anaphylaxis have been identified as potential adverse effects induced by checkpoint inhibitor−monoclonal antibodies. Drug desensitization is a safe and effective treatment option for patients who experience hypersensitivity reactions in need of these monoclonal antibodies to improve cancer outcomes.

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Update on Desensitization

Cited by 6 publications

References 48 publications

Atopy, allergen sensitization and development of hypersensitivity reactions to paclitaxel

Atopy, allergen sensitization and development of hypersensitivity reactions to paclitaxel

Case Report: Maintenance of Desensitization to Nebulized Colomycin Over 10 Years

Hypersensitivity reactions and anaphylaxis to checkpoint inhibitor–monoclonal antibodies and desensitization

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