Drug Desensitizations in the Management of Allergy and Anaphylaxis to Chemotherapeutic Agents and Monoclonal Antibodies

Drug desensitization is the process of safely administering a needed medication to a drug-allergic individual. The procedure involves the cautious administration of incremental doses of the drug over a period of hours to days and it is used primarily in the management of IgE-mediated drug hypersensitivity reactions. Desensitization has also safely been used for drug hypersensitivity reactions that result in mast cell degranulation that are not IgE-mediated. Desensitization is antigen-specific or drug-specific and is sustained only as long as the drug is continuously administered. The recommendation for drug desensitization should be made along with an Allergy and Immunology specialist. While most of the desensitization protocols published in the literature have involved antibiotics, this principle, in recent years, has been applied successfully to other agents including chemotherapeutic agents, monoclonal antibodies, aspirin, allopurinol, insulin, vaccines, and other protein and small molecule therapeutics alike. In this chapter, we focus primarily on using drug desensitizations in the management of allergy to chemotherapeutic agents and monoclonal antibodies. What began as a method of administering antibiotics to sensitized individuals for the treatment of life-threatening infectious disease has now become a means of safely treating numerous cancers and rheumatologic diseases with needed chemotherapies.