Rapid drug desensitization in children: A single-center experience

Drug hypersensitivity reactions (HSRs) in children often necessitate discontinuation of essential therapies. Rapid drug desensitization (RDD) is a key strategy to enable safe re-exposure; however, pediatric data remain limited.

This retrospective study included 59 pediatric patients (0-18 years) who underwent RDD between September 2019 and January 2025 at a tertiary pediatric allergy center. Demographics, HSR characteristics, premedication strategies, desensitization protocols, and breakthrough reactions (BRs) were analyzed. A total of 1978 procedures were performed using 62 protocols for 27 different drugs, including antimicrobials, enzyme replacement therapies (ERTs), immunomodulators, chemotherapeutics, and other agents.

Fifty-nine patients underwent 1978 RDD procedures. Of these, 58 patients successfully completed desensitization, while treatment modification was required in one patient. In total, 1977 protocols were successfully completed, with only one protocol failure, corresponding to an overall success rate exceeding 99%. BRs reactions occurred in 0.6% (n = 12) of procedures; most were mild to moderate and effectively managed without discontinuation of the protocol. Premedication regimens were individualized according to the drug administered and patient characteristics.

This study represents one of the largest pediatric RDD series to date, demonstrating high efficacy and a favorable safety profile across a wide range of drug classes. Pediatric RDD should be considered a reliable therapeutic option in children with drug hypersensitivity when alternatives are lacking.