Castells Mariana C, Tennant Nichole M, Sloane David E, Hsu F Ida, Barrett Nora A, Hong David I, Laidlaw Tanya M, Legere Henry J, Nallamshetty Samridhi N, Palis Ross I, Rao Jayanti J, Berlin Suzanne T, Campos Susana M, Matulonis Ursula A
Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
J Allergy Clin Immunol. 2008 Sep;122(3):574-80. doi: 10.1016/j.jaci.2008.02.044. Epub 2008 May 27.
Hypersensitivity reactions (HSRs) to chemotherapeutic drugs, including mAbs, often require that the provoking medication be discontinued, thus raising a dilemma for the caregiver: further use could precipitate a severe, even fatal, allergic reaction on re-exposure, but alternative drugs might be poorly tolerated or much less effective compared with the preferred agent.
We have developed a standardized rapid desensitization protocol for achieving temporary tolerization to drug allergens. In this study we evaluate the safety and efficacy of this protocol.
Ninety-eight patients who had HSRs in response to treatment with carboplatin, cisplatin, oxaliplatin, paclitaxel, liposomal doxorubicin, doxorubicin, or rituximab received rapid desensitization to these agents. A standardized 12-step protocol was used, with treatment given intravenously or intraperitoneally. Initial desensitizations occurred in the medical intensive care unit, whereas most subsequent infusions took place in an outpatient setting. Safety and efficacy of the protocol were assessed by review of treatment records.
Of the 413 desensitizations performed, 94% induced mild or no reactions. No life-threatening HSRs or deaths occurred during the procedure, and all patients received their full target dose. Most reactions occurred during the first desensitization. Reactions were most commonly reported at the last step of the protocol. Desensitizations through the intravenous and intraperitoneal routes were equally effective.
Our standardized 12-step protocol for rapid drug desensitization is safe and effective and has been adopted as the standard of care at our institutions in treating patients with HSRs to chemotherapeutic drugs, including mAbs.
对包括单克隆抗体在内的化疗药物的超敏反应（HSR）通常要求停用引发反应的药物，这给护理人员带来了两难境地：继续使用可能会在再次接触时引发严重甚至致命的过敏反应，但与首选药物相比，替代药物可能耐受性差或效果差得多。
我们制定了一种标准化的快速脱敏方案，以实现对药物过敏原的临时耐受。在本研究中，我们评估了该方案的安全性和有效性。
98例对卡铂、顺铂、奥沙利铂、紫杉醇、脂质体阿霉素、阿霉素或利妥昔单抗治疗产生HSR的患者接受了对这些药物的快速脱敏。使用标准化的12步方案，通过静脉或腹腔给药。最初的脱敏在医学重症监护病房进行，而大多数后续输注在门诊进行。通过审查治疗记录评估该方案的安全性和有效性。
在进行的413次脱敏中，94%引起轻度反应或无反应。在该过程中未发生危及生命的HSR或死亡，所有患者均接受了完整的目标剂量。大多数反应发生在第一次脱敏期间。反应最常报告在方案的最后一步。静脉和腹腔途径的脱敏同样有效。
我们标准化的12步快速药物脱敏方案安全有效，已被我们机构用作治疗对包括单克隆抗体在内的化疗药物有HSR的患者的护理标准。
