Medication Desensitization: Characterization of Outcomes and Risk Factors for Reactions

Area of Science:

• Immunology
• Pharmacology
• Clinical Medicine

Background:

• Drug desensitization induces temporary immune unresponsiveness for patients with IgE-, non-IgE-, or pharmacologically mediated reactions when no alternatives exist.
• The precise mechanisms underlying drug desensitization remain incompletely understood.

Purpose of the Study:

• To characterize the outcomes of drug desensitization procedures.
• To identify risk factors associated with adverse reactions during drug desensitization.

Main Methods:

• Retrospective review of electronic medical records for adult patients undergoing drug desensitization between January 2011 and December 2013.
• Multivariate analysis to assess the association between risk factors and reactions during desensitization.
• Classification of reactions based on cutaneous manifestations and procedural outcomes (successful, mild, moderate, failed).

Main Results:

• Eighty-eight desensitizations were performed in 69 patients, with 85% completed without cutaneous reactions.
• No baseline characteristic, medication class, or indication for desensitization was significantly associated with experiencing a reaction.
• Prior history of urticaria or labored breathing during drug exposure was associated with increased likelihood of reaction, but not independently in multivariate analysis.

Conclusions:

• Drug desensitization is a safe therapeutic option for patients with limited treatment alternatives.
• A history of urticaria or labored breathing during prior drug exposure is linked to an increased risk of reactions during desensitization.