Caimmi Silvia, Caffarelli Carlo, Saretta Francesca, Liotti Lucia, Crisafulli Giuseppe, Cardinale Fabio, Bottau Paolo, Mori Francesca, Franceschini Fabrizio, Bernardini Roberto, Marseglia Gian Luigi
Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Acta Biomed. 2019 Jan 28;90(3-S):20-29. doi: 10.23750/abm.v90i3-S.8158.
Drug allergy is an increasing problem worldwide, affecting all populations and races, children and adults, and for which diagnosis and treatment are not well standardized yet. Besides classical treatments, new drugs have been developed, especially for patients suffering from malignancies and chronic inflammatory diseases, that specifically target the cause of the disease. For those patients requiring such molecules, it is sometimes difficult to find an alternative drug when hypersensitivity reactions occur. Desensitization is therefore the best option whenever no alternative therapy is available but also when alternative treatments are considered therapeutically inferior and or more toxic. Despite its clinical success, little is known about the mechanisms and molecular targets of drug desensitization. Desensitization protocols use a gradual dose escalation to allow the safe administration of a treatment to which a patient previously presented a hypersensitivity reaction. The procedure requires special training and coordination of an allergy team, including physicians, nurses, and pharmacists, working together to safely and successfully implement desensitization protocols when appropriate. There is no difference in desensitization protocol between adults and children, except for the final cumulative dose of the administered drug.
药物过敏在全球范围内是一个日益严重的问题,影响着所有人群和种族,包括儿童和成人,而且其诊断和治疗尚未得到很好的标准化。除了传统治疗方法外,还开发了新药,特别是针对患有恶性肿瘤和慢性炎症性疾病的患者,这些新药专门针对疾病的病因。对于那些需要此类分子的患者,当发生超敏反应时,有时很难找到替代药物。因此,无论何时没有替代疗法可用,或者替代疗法在治疗上被认为较差和/或毒性更大时,脱敏都是最佳选择。尽管脱敏在临床上取得了成功,但人们对其机制和分子靶点知之甚少。脱敏方案采用逐渐增加剂量的方法,以使患者能够安全地接受之前出现过超敏反应的治疗。该程序需要过敏团队(包括医生、护士和药剂师)进行特殊培训和协调,他们共同努力,在适当的时候安全、成功地实施脱敏方案。成人和儿童的脱敏方案没有区别,只是所给药的最终累积剂量有所不同。