J Investig Allergol Clin Immunol. 2014;24(2):72-9; quiz 2 p following 79.
The frequency of hypersensitivity reactions (HSR) to drugs has risen in the last 10 years owing to increased exposure to better and more allergenic medications including monoclonal antibodies. HSRs prevent patients from using their first-line therapy, leading to decreased quality of life and life expectancy. Although premedication with antihistamines, leukotriene blockers, and corticosteroids can protect against mild-to-moderate HSR, none of these medications has provided protection against anaphylaxis. Rapid drug desensitization is a treatment option for patients with HSR to their first-line medication that protects against anaphylaxis.Although the mechanisms of drug desensitization are not completely understood, in vitro mast cell models of IgE antigen desensitization have led to the design of safe and effective in vivo protocols aimed at protecting highly sensitized patients from hypersensitivity reactions and anaphylaxis. This review provides an insight into the mechanisms of IgE/mast cell desensitization, the principles and practice of drug desensitization, and an overview of the different desensitization protocols and their safety and efficacy profiles. Drug desensitization should only be performed by allergists, trained nurses, and experienced pharmacists, since this high-risk procedure involves reintroducing allergenic medication to highly sensitized patients, with the consequent potential for severe or fatal HSRs.
在过去的 10 年中，由于更好、更具致敏性的药物（包括单克隆抗体）的广泛使用，药物超敏反应（HSR）的频率有所上升。HSR 会使患者无法使用一线疗法，导致生活质量和预期寿命下降。尽管抗组胺药、白三烯受体阻滞剂和皮质类固醇的预先给药可以预防轻度至中度 HSR，但这些药物都不能预防过敏反应。对于对一线药物发生 HSR 的患者，快速药物脱敏是一种治疗选择，可预防过敏反应。尽管药物脱敏的机制尚未完全阐明，但针对 IgE 抗原脱敏的体外肥大细胞模型已导致设计出安全有效的体内方案，旨在保护高度致敏的患者免受过敏反应和过敏反应。本文综述了 IgE/肥大细胞脱敏的机制、药物脱敏的原理和实践，以及不同脱敏方案及其安全性和疗效概况。药物脱敏只能由过敏症专家、经过培训的护士和经验丰富的药剂师进行，因为这是一种高风险的程序，需要将致敏性药物重新引入高度致敏的患者，随之而来的是严重或致命 HSR 的潜在风险。
