Breakthrough reactions during rapid drug desensitization: Clinical outcome and risk factors

被引：12

作者：

Kang, Yewon ^{[1
,2
,3
]}

Kwon, Oh Young ^{[1
,2
]}

Jung, Heewon ^{[1
,4
]}

Kang, Minkyoung ^{[2
]}

An, Jin ^{[1
,2
]}

Lee, Ji-Hyang ^{[1
,2
]}

Won, Ha-Kyeong ^{[1
,2
,5
]}

Song, Woo-Jung ^{[1
,2
]}

Kwon, Hyouk-Soo ^{[1
,2
]}

Cho, You Sook ^{[1
,2
]}

Moon, Hee-Bom ^{[1
,2
]}

Kim, Tae-Bum ^{[1
,2
]}

机构：

[1] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Allergy & Clin Immunol, 88 Olymp Ro,43 Gil, Seoul 05505, South Korea

[2] Asan Med Ctr, Pharmacovigilance Ctr, Seoul, South Korea

[3] Pusan Natl Univ, Sch Med, Dept Internal Med, Busan, South Korea

[4] Chung Ang Grad Univ, Dept Appl Stat, Seoul, South Korea

[5] VHS Med Ctr, Dept Internal Med, Seoul, South Korea

来源：

ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY | 2019年 / 123卷 / 01期

关键词：

HYPERSENSITIVITY REACTIONS; CHEMOTHERAPY; PROTOCOL; OXALIPLATIN; EXPERIENCE; ALLERGY; AGENTS; SYK;

D O I：

10.1016/j.anai.2019.05.007

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

Background: Severe hypersensitivity reactions (HSRs) interfere with the administration of necessary drugs for patients; drug desensitization can be a good alternative strategy. Although rapid drug desensitization (RDD) has been shown to be safe and effective, some patients still experience breakthrough reactions (BTRs) during desensitization. Objective: We aimed to estimate clinical outcomes of RDD and to identify risk factors for BTR. Methods: From January 2015 to December 2017, retrospective analysis was done in cancer patients with HSRs to chemotherapy and monoclonal antibody who underwent 3-bag, 12-step RDD in Asan Medical Center. Results: A total of 58 patients (42 females; mean age, 54.7 +/- 11.0) underwent 234 desensitization procedures. The most common underlying malignancy was gynecologic cancer (n = 26, 44.8%), and platinum-based drugs were common target drugs (135 cases of 36 patients). Twenty-six of 58 patients (44.8%) experienced 56 BTRs, whereas 178 cases (76.1%) of total desensitization did not show any reactions. Among them, 12 patients (20.7%) had moderate BTRs requiring systemic steroids, and 3 (5.1%) experienced severe BTRs requiring epinephrine administration. Logistic regression analysis revealed more severe initial HSRs (OR = 17.94, 95% CI = 1.78-181.68, P = .015), drug allergy history (OR = 7.83, 95% CI = 1.48-41.44, P = .035), and frequency of exposure to the chemotherapeutic agents (OR = 1.14, 95% CI = 1.01-1.28, P = .016) increased the risk of moderate to severe BTR. Conclusion: The standardized 12-step protocol for RDD was effective and safe for most patients. Severity of initial HSR, history of drug allergy, and previous high exposure to the chemotherapeutic agent showed a positive correlation with BTR above moderate grade. Studies are needed to propose an individualized protocol according to patient-specific risk assessment. (C) 2019 American College of Allergy, Asthma & Immunology. All rights reserved.

引用

页码：48 / +

页数：10

共 37 条

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