抗 mAb 过敏反应：23 例患者共 105 次脱敏治疗，从评估到治疗。
Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment.
机构信息
Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
出版信息
J Allergy Clin Immunol. 2009 Dec;124(6):1259-66. doi: 10.1016/j.jaci.2009.09.009.
BACKGROUND
Rapid desensitization, a procedure for graded drug administration, allows for the safe readministration of a medication after certain types of hypersensitivity reactions (HSRs) and is indicated in cases in which there are no reasonable therapeutic alternatives. The use of rapid desensitization for HSRs to mAbs has not been validated.
OBJECTIVE
We sought to describe our experience with rapid desensitization to mAbs, including rituximab, infliximab, and trastuzumab.
METHODS
One hundred five rapid desensitizations were performed in 23 patients with a standardized 12-step, 6-hour protocol. Our approach to patient evaluation before desensitization is described. The severity, characteristics, and timing of both initial HSRs and HSRs during desensitization were determined by means of retrospective review of medical records. After a reaction during desensitization, patient-specific protocol modifications were made before each subsequent desensitization.
RESULTS
104 of 105 desensitizations undertaken were successfully completed. We observed HSRs during 29% of desensitizations, including 27 mild reactions, 1 moderate reaction, and 2 severe reactions. Overall, reactions during desensitization were markedly less severe than initial HSRs, but reactions did recur in a minority of successive desensitizations.
CONCLUSIONS
Rapid desensitization is a promising method for the delivery of monoclonal therapeutics after an HSR, but the possibility of a reaction remains with each desensitization.
背景
快速脱敏是一种分级药物给药程序，可在发生某些类型的超敏反应（HSR）后安全地重新给予药物，并且在没有合理治疗选择的情况下使用。快速脱敏用于针对 mAb 的 HSR 尚未得到验证。
目的
我们旨在描述我们使用快速脱敏治疗针对 mAb 的经验，包括利妥昔单抗、英夫利昔单抗和曲妥珠单抗。
方法
在 23 名患者中进行了 105 次快速脱敏治疗，采用标准化的 12 步、6 小时方案。我们描述了脱敏前患者评估的方法。通过回顾病历确定初始 HSR 和脱敏过程中 HSR 的严重程度、特征和时间。在脱敏过程中发生反应后，在每次随后的脱敏之前，都会针对特定患者修改方案。
结果
105 次脱敏中有 104 次成功完成。我们观察到 29%的脱敏过程中出现了 HSR，包括 27 例轻度反应、1 例中度反应和 2 例严重反应。总体而言，脱敏过程中的反应明显比初始 HSR 轻，但在少数连续脱敏中确实会再次发生反应。
结论
快速脱敏是在发生 HSR 后给予单克隆治疗药物的一种有前途的方法，但每次脱敏都仍存在发生反应的可能性。
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