BACKGROUND: Rapid drug desensitization (RDD) is used to address hypersensitivity reactions to chemotherapeutics and monoclonal antibodies, allowing patients to be treated with optimal pharmacological agents. RDD protocols are tailored to each individual patient's reaction and needs, and protect against anaphylaxis, but overall risks, costs, and benefits have not been determined. OBJECTIVE: We investigated the safety, efficacy, costs, and life expectancy of patients in a large population undergoing RDD. METHODS: We analyzed 2177 RDD procedures performed in 370 patients with cancer, vasculitis, and hematological and connective tissue diseases who presented 402 reactions. A subgroup of carboplatin allergic patients with ovarian cancer treated with RDD was analyzed for costs and life expectancy and compared with a nonallergic control group. RESULTS: RDD allowed all patients to receive safely the full dose of the medication to which they were reactive. A gradual increase in the fraction of outpatient desensitizations from 81% to 98% was achieved through risk stratification. Of the 2177 desensitizations, 93% had no or mild reactions whereas 7% had moderate to severe reactions, which did not preclude the completion of the treatment, and there were no deaths. Overall health costs in the carboplatin allergic group were not higher than those in the nonallergic group treated with standard of care. Administration of carboplatin through RDD was as effective as standard administration with a nonsignificant increase in life expectancy in desensitized patients as compared with nonallergic, nondesensitized controls. CONCLUSIONS: RDD is cost effective and safe for allergic patients with cancer and chronic disease to remain on first line therapy.
BACKGROUND: Rapid drug desensitization (RDD) is used to address hypersensitivity reactions to chemotherapeutics and monoclonal antibodies, allowing patients to be treated with optimal pharmacological agents. RDD protocols are tailored to each individual patient's reaction and needs, and protect against anaphylaxis, but overall risks, costs, and benefits have not been determined. OBJECTIVE: We investigated the safety, efficacy, costs, and life expectancy of patients in a large population undergoing RDD. METHODS: We analyzed 2177 RDD procedures performed in 370 patients with cancer, vasculitis, and hematological and connective tissue diseases who presented 402 reactions. A subgroup of carboplatinallergicpatients with ovarian cancer treated with RDD was analyzed for costs and life expectancy and compared with a nonallergic control group. RESULTS: RDD allowed all patients to receive safely the full dose of the medication to which they were reactive. A gradual increase in the fraction of outpatient desensitizations from 81% to 98% was achieved through risk stratification. Of the 2177 desensitizations, 93% had no or mild reactions whereas 7% had moderate to severe reactions, which did not preclude the completion of the treatment, and there were no deaths. Overall health costs in the carboplatinallergic group were not higher than those in the nonallergic group treated with standard of care. Administration of carboplatin through RDD was as effective as standard administration with a nonsignificant increase in life expectancy in desensitized patients as compared with nonallergic, nondesensitized controls. CONCLUSIONS: RDD is cost effective and safe for allergicpatients with cancer and chronic disease to remain on first line therapy.
Authors: Timothy E Dribin; David Schnadower; Julie Wang; Carlos A Camargo; Kenneth A Michelson; Marcus Shaker; Susan A Rudders; David Vyles; David B K Golden; Jonathan M Spergel; Ronna L Campbell; Mark I Neuman; Peter S Capucilli; Michael Pistiner; Mariana Castells; Juhee Lee; David C Brousseau; Lynda C Schneider; Amal H Assa'ad; Kimberly A Risma; Rakesh D Mistry; Dianne E Campbell; Margitta Worm; Paul J Turner; John K Witry; Yin Zhang; Brad Sobolewski; Hugh A Sampson Journal: J Allergy Clin Immunol Date: 2021-08-12 Impact factor: 10.793
Authors: Salvador Alonso Martinez; Neil H Segal; Andrea Cercek; Rona Yaeger; Zsofia Stadler; Nancy E Kemeny; Maliha Nusrat; Armin Shahrokni; Louise Connell; Leonard B Saltz Journal: Clin Colorectal Cancer Date: 2022-01-19 Impact factor: 4.035
Authors: Marat V Khodoun; Suzanne C Morris; Elizabeth Angerman; Crystal Potter; Richard Schuman; Mark Wunderlich; Joseph J Maciag; Kathryn C Sullivan Locker; James C Mulloy; Andrew B Herr; Fred D Finkelman Journal: J Allergy Clin Immunol Date: 2019-12-11 Impact factor: 10.793
Authors: Suzanne C Morris; Charles Perkins; Crystal Potter; David Parsons; Richard Schuman; Marat V Khodoun; Unni Samavedam; Richard Strait; Fred D Finkelman Journal: J Allergy Clin Immunol Date: 2021-06-26 Impact factor: 14.290