Rapid drug desensitization in pediatric patients: A multicenter study

Drug hypersensitivity is often managed by drug desensitization, yet published data remain scarce in children. This study evaluated the safety and efficacy of rapid desensitization to chemotherapeutic agents, monoclonal antibodies, and disease-modifying antirheumatic drugs (DMARDs).

To evaluate the safety and efficacy of rapid desensitization for managing drug hypersensitivity in pediatric patients.

This is a multicenter retrospective analysis of rapid drug desensitizations performed at Boston Children's Hospital, Hong Kong Children's Hospital, and Queen Mary Hospital from January 2013 to December 2022. Demographic information, hypersensitivity reactions (HSRs) to drugs, premedications, desensitization protocols and modifications, and breakthrough reactions during desensitization were extracted from the medical charts. The associations between these factors and the occurrences of HSRs were assessed.

A total of 23 patients (median age, 9.5 years; 57% male) underwent 26 rapid drug desensitizations. The underlying diagnoses included solid tumors (65%, n = 15), leukemia (13%, n = 3), and other medical conditions (22%, n = 5). The drugs desensitized included chemotherapeutics, monoclonal antibodies, and DMARDs. Most desensitizations (96%, n = 25) involved premedication with 1 to 5 drugs, such as antihistamines, steroids, leukotriene inhibitors, and nonsteroidal anti-inflammatory drugs. Six desensitizations (23%) resulted in mild breakthrough reactions. One patient experienced clinical anaphylaxis. Most desensitizations were successful and allowed the use of the desensitized drug. A greater number of premedications was associated with the lack of breakthrough reactions (P = .047).

Rapid drug desensitization was safe and effective in managing pediatric patients with hypersensitivity to chemotherapeutic agents, monoclonal antibodies, and DMARDs. Premedication is useful in preventing breakthrough reactions.