Pardo-Manrique Verónica, Ramírez-Zuluaga Luis Fernando, Silva-Espinosa Diana Lucia, Hurtado-Bermudez Leidy Johanna, Gómez-Hernández Inés Elvira, Olaya-Hernández Manuela, Serrano-Reyes Carlos Daniel
Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
Front Allergy. 2024 Aug 30;5:1460326. doi: 10.3389/falgy.2024.1460326. eCollection 2024.
Drug hypersensitivity reactions (DHRs) have a significant impact on both, patient and their treating physicians; it is considered a public health concern. The history of allergy to drugs, limits therapeutic options and will lead to the use of more expensive and potentially less effective options. Drug desensitization (DD) is considered as a procedure with a positive impact on the prognosis of the patient's disease. The objective of this study is to describe the experience with a substantial number of drugs desensitization in a fourth level center in Cali, Colombia.
An observational, cross-sectional and descriptive study was conducted. Patients with DHRs who underwent a standardized institutional DD protocol, between March of 2012 and May of 2023, were included.
Two hundred forty-one patients were included. The median age was 47.8 years (4-88). One hundred fifty-six (64.7%) were women, including three who were pregnant. A total of 641 DDs were performed. The most frequent groups of drugs for which the desensitization was performed were monoclonal antibodies in 83 patients (34.4%), chemotherapeutic agents in 53 (21.6%), NSAIDs in 44 (18.2%), and antibiotics in 42 (17.4%). Eighty-seven patients (36.1%) experienced hypersensitivity to the culprit drug on first exposure, while 154 (63.9%) exhibited reactions during subsequent cycles. The main clinical presentation that gave rise to desensitization was anaphylaxis in 125 patients (51.8%), followed by cutaneous symptoms in 106 patients (44%). The predominant observed endophenotype was type 1 in 188 patients (78.3%), followed by mixed type in 46 patients (19.2%). Breakthrough reactions were observed in 50 patients (20.7%). Tolerance to DD was achieved in 636 of the procedures (99.2%), allowing the continuity of treatment of choice for the underlying disease.
Most desensitized patients were women with type I reactions. Monoclonal antibodies were the most frequent culprit drugs. DD in patients with DHRs is a useful, safe and effective procedure. The administration of the implicated drug had a positive impact on the course of the disease in these patients.
药物过敏反应（DHRs）对患者及其治疗医生均有重大影响；它被视为一个公共卫生问题。药物过敏史限制了治疗选择，并将导致使用更昂贵且可能效果较差的治疗方案。药物脱敏（DD）被认为是一种对患者疾病预后有积极影响的治疗方法。本研究的目的是描述哥伦比亚卡利市一家四级医疗中心大量药物脱敏治疗的经验。
进行了一项观察性、横断面和描述性研究。纳入了2012年3月至2023年5月期间接受标准化机构药物脱敏方案治疗的药物过敏反应患者。
共纳入241例患者。中位年龄为47.8岁（4 - 88岁）。156例（64.7%）为女性，其中包括3例孕妇。共进行了641次药物脱敏治疗。进行脱敏治疗最常见的药物类别为单克隆抗体，共83例患者（34.4%），其次是化疗药物53例（21.6%）、非甾体抗炎药44例（18.2%）以及抗生素42例（17.4%）。87例患者（36.1%）在首次接触可疑药物时出现过敏反应，而154例（63.9%）在后续疗程中出现反应。引发脱敏治疗的主要临床表现为125例患者（51.8%）出现过敏反应，其次是106例患者（44%）出现皮肤症状。观察到的主要内表型为1型，共188例患者（78.3%），其次是混合型46例患者（19.2%）。50例患者（20.7%）出现了突破性反应。636次治疗（99.2%）实现了对药物脱敏的耐受，从而使基础疾病的首选治疗得以继续。
大多数接受脱敏治疗的患者为I型反应的女性。单克隆抗体是最常见的可疑药物。药物过敏反应患者的药物脱敏治疗是一种有用、安全且有效的治疗方法。给予相关药物对这些患者的疾病进程有积极影响。
