Desensitization for drug hypersensitivity

摘要

Castells et al from Brigham and Women's and Dana Farber hospitals publish in this issue their large experience with rapid dose escalation of chemotherapeutic drugs leading to safe retreat-ment after earlier acute infusion reactions (AIRs). They report 100% success in achieving therapeutic doses for 2 classes of AIRs with distinctly different mechanisms: (1) IgE-dependent anaphylaxis after multiple courses of immunogenic platinum-containing chemotherapeutics (carboplatin, cisplatin, oxaliplatin); and (2) pseudoallergic AIR syndromes elicited by paclitaxel, dox-orubicin, and biologies like the anti-CD20 mAb rituximab. For the latter group, AIRs are commonly encountered with the first dose and involve a variety of mechanisms including complement activation by lipophilic excipients, possible tumor lysis, and other complex biologic effects (eg, cytokine or anticytokine infusions). Some but not all manifestations of these pseudoallergic syndromes can be abrogated by slower infusion rates and by premedications, including steroids given at least 12 hours before infusions.