Breslow Rebecca G, Caiado Joana, Castells Mariana C
Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Ann Allergy Asthma Immunol. 2009 Feb;102(2):155-60. doi: 10.1016/S1081-1206(10)60247-5.
Rapid desensitization is a process in which drug-allergic patients receive their target dose in incremental steps, resulting in a state of temporary tolerization. In this manner, first-line therapy can be delivered safely, even in patients who present with severe hypersensitivity reactions (HSRs) to the given agent. A small subset of patients has persistent HSRs during rapid desensitization that can be refractory to antihistamines and corticosteroids.
To increase the safety and tolerability of rapid desensitization by prostaglandin and leukotriene blockade in patients with refractory mast cell mediator-related symptoms.
Fourteen adult patients developed HSRs to platinum chemotherapy that persisted during rapid desensitization. All patients had cutaneous symptoms (flushing, pruritus, or urticaria), many with associated systemic reactions. These patients were then pretreated with acetylsalicylic acid, 325 mg orally, and montelukast, 10 mg orally, 2 days before and on the day of desensitization. Response to subsequent desensitizations was assessed by medical record review and was compared with a group of matched historic control patients who received methylprednisolone for HSRs during desensitization.
Seventy-eight desensitizations in 14 patients were performed. Using acetylsalicylic acid and montelukast, 86% of patients (12/14) experienced substantial improvement in symptoms (grade 0.5 vs grade 2.14, P < .0001). Reduction in symptoms during desensitization was also significantly greater than that experienced by historic control patients who received methylprednisolone pretreatment (grade 0.5 vs grade 1.75, P = .0008). All patients received their target dose of chemotherapy, and there were no severe systemic HSRs.
Pretreatment with acetylsalicylic acid and montelukast lessens the severity of HSRs during rapid desensitization.
快速脱敏是一个过程，在此过程中药物过敏患者以递增步骤接受其目标剂量，从而导致暂时耐受状态。通过这种方式，即使是对给定药物出现严重过敏反应（HSR）的患者，也可以安全地进行一线治疗。一小部分患者在快速脱敏过程中会出现持续性HSR，这些反应可能对抗组胺药和皮质类固醇难治。
通过阻断前列腺素和白三烯来提高难治性肥大细胞介质相关症状患者快速脱敏的安全性和耐受性。
14名成年患者对铂类化疗出现HSR，这些反应在快速脱敏过程中持续存在。所有患者均有皮肤症状（潮红、瘙痒或荨麻疹），许多患者伴有全身反应。然后在脱敏前2天和脱敏当天，这些患者口服325毫克乙酰水杨酸和10毫克孟鲁司特进行预处理。通过病历回顾评估对后续脱敏的反应，并与一组在脱敏期间因HSR接受甲泼尼龙治疗的匹配历史对照患者进行比较。
对14名患者进行了78次脱敏。使用乙酰水杨酸和孟鲁司特，86%的患者（12/14）症状有显著改善（0.5级对2.14级，P <.0001）。脱敏期间症状的减轻也明显大于接受甲泼尼龙预处理的历史对照患者（0.5级对1.75级，P =.0008）。所有患者均接受了目标剂量的化疗，且未出现严重的全身性HSR。
乙酰水杨酸和孟鲁司特预处理可减轻快速脱敏期间HSR的严重程度。
