Hypersensitivity reactions to chemotherapy: Outcomes and safety of rapid desensitization in 413 cases
Hypersensitivity reactions to chemotherapy: Outcomes and safety of rapid desensitization in 413 cases
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DOI：
10.1016/j.jaci.2008.02.044
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发表时间：
2008-09-01
影响因子：
14.2
通讯作者：
Matulonis, Ursula A.
中科院分区：
文献类型：
--
作者：
Castells, Mariana C.;Tennant, Nichole M.;Matulonis, Ursula A.
背景：对化疗药物（包括单克隆抗体）的超敏反应（HSRs）通常需要停药，因此给护理人员带来了一个困境：进一步使用可能会在再次暴露时引发严重甚至致命的过敏反应，但替代药物可能耐受性差或与首选药物相比效果更差。目的：我们开发了一种标准化的快速脱敏方案，以实现对药物过敏原的暂时耐受。在本研究中，我们评估了该方案的安全性和有效性。方法：98例接受卡铂、顺铂、奥沙利铂、紫杉醇、阿霉素脂质体、阿霉素或利妥昔单抗治疗后出现HSRs的患者对这些药物进行快速脱敏治疗。采用标准化的12步方案，通过静脉或腹腔给予治疗。最初的脱敏发生在医疗重症监护病房，而大多数后续输液发生在门诊环境。通过回顾治疗记录来评估该方案的安全性和有效性。结果：在进行的413例脱敏治疗中，94%的患者引起轻微或无反应。手术过程中没有发生危及生命的hsr或死亡，所有患者都接受了全部目标剂量。大多数反应发生在第一次脱敏期间。反应最常在方案的最后一步报告。通过静脉和腹腔途径脱敏同样有效。结论：我们标准化的12步快速药物脱敏方案是安全有效的，并已被我们的机构采用作为治疗hsr患者化疗药物的护理标准，包括单克隆抗体。
Background: Hypersensitivity reactions (HSRs) to chemotherapeutic drugs, including mAbs, often require that the provoking medication be discontinued, thus raising a dilemma for the caregiver: further use could precipitate a severe, even fatal, allergic reaction on re-exposure, but alternative drugs might be poorly tolerated or much less effective compared with the preferred agent.Objective: We have developed a standardized rapid desensitization protocol for achieving temporary tolerization to drug allergens. In this study we evaluate the safety and efficacy of this protocol.Methods: Ninety-eight patients who had HSRs in response to treatment with carboplatin, cisplatin, oxaliplatin, paclitaxel, liposomal doxorubicin, doxorubicin, or rituximab received rapid desensitization to these agents. A standardized 12-step protocol was used, with treatment given intravenously or intraperitoneally. Initial desensitizations occurred in the medical intensive care unit, whereas most subsequent infusions took place in an outpatient setting. Safety and efficacy of the protocol were assessed by review of treatment records.Results: Of the 413 desensitizations performed, 94% induced mild or no reactions. No life-threatening HSRs or deaths occurred during the procedure, and all patients received their full target dose. Most reactions occurred during the first desensitization. Reactions were most commonly reported at the last step of the protocol. Desensitizations through the intravenous and intraperitoneal routes were equally effective.Conclusions: Our standardized 12-step protocol for rapid drug desensitization is safe and effective and has been adopted as the standard of care at our institutions in treating patients with HSRs to chemotherapeutic drugs, including mAbs.