Alvarez-Cuesta Emilio, Madrigal-Burgaleta Ricardo, Broyles Ana D, Cuesta-Herranz Javier, Guzman-Melendez Maria Antonieta, Maciag Michelle C, Phillips Elizabeth J, Trubiano Jason A, Wong Johnson T, Ansotegui Ignacio
Ramon y Cajal University Hospital, Madrid, Spain.
Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
World Allergy Organ J. 2022 May 31;15(6):100640. doi: 10.1016/j.waojou.2022.100640. eCollection 2022 Jun.
Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients. Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally. The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe. This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning care (including a specific supplemental section on a real-life example of how to design a dedicated space that can combine basic and complex diagnostic and therapeutic techniques in allergy).
静脉用药引起的药物超敏反应（DHRs）可能很严重，可能会使患者和医生陷入困境，不得不暂停必要的治疗或干预措施。实际上，几乎任何静脉用药都有可能引发危及生命的DHR，但化疗药物、生物制剂和抗生素是这些反应中最常涉及的静脉用药。诚然，暂停此类治疗可能会对受影响患者的生存结果或生活质量产生负面影响。去标签化途径和快速药物脱敏（RDD）可以帮助有反应的患者继续使用首选疗法，而不是转向疗效较差、成本效益较低或毒性更大的替代疗法。然而，这些都是高复杂性和高风险的技术，通常需要专家团队和特定的过敏技术（皮肤试验、检测、药物激发试验）来确保安全、准确诊断和个性化管理。不幸的是，在获得具备提供这些技术并最佳应对这些DHR所需专业知识和资源的过敏科方面，国家内部和国家之间存在显著不平等。本共识文件的主要目标是通过帮助过敏科医生扩大其执业范围，并为他们提供来自全球领先团队的证据、数据和经验，为全球患者带来巨大益处。世界过敏组织（WAO）药物超敏反应委员会的这份声明旨在成为一份关于对多种药物实施急性发作静脉超敏反应去标签化和RDD技术方面的全面实用指南。因此，该手稿不仅关注临床途径。相反，它还就通常未涉及的主题提供指导，即内部验证、持续质量改进、营造健康的多学科环境以及重新设计护理（包括一个关于如何设计一个能够结合过敏基本和复杂诊断及治疗技术的专用空间的实际案例的特定补充章节）。
