Asthma Allergy Immunology

Asthma Allergy Immunology

2024, Vol 22, Num, 2     (Pages: 170-180)

Rapid Drug Desensitization and Management of Breakthrough Reactions in Pediatric Patients

Betul GEMICI KARAASLAN 1, Sezin AYDEMIR 1, Zeynep MERIC 1, Esra KARABAG YILMAZ 2, Ceren BIBINOGLU AMIROV 3, Tugce Damla DILEK 3, Suheyla OCAK 4, Ayse Ayzit KILINC SAKALLI 5, Sema SALTIK 3, Nur CANPOLAT 2, Ozgur KASAPCOPUR 6, Esra YUCEL 1, Haluk COKUGRAS 1, Ayca KIYKIM 1,

1 Department of Pediatric Allergy and Immunology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
2 Department of Pediatric Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
3 Department of Pediatric Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
4 Department of Pediatric Hematology and Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
5 Department of Pediatrics, Division of Chest Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
6 Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye

DOI: 10.21911/aai.2024.579
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Objective: Rapid drug desensitization (RDD) is a safe and effective method of inducing temporary tolerance and gradually increasing the dose over a few hours to a few days, thereby preventing severe hypersensitivity reactions. Despite the limited number of pediatric desensitization studies in the literature, it is important to explore this area further to provide better treatment options for patients. This study will determine the safety and efficacy of desensitization and present management strategies for breakthrough reactions in pediatric patients with immediate hypersensitivity reactions (HSR).

Materials and Methods: This retrospective study enrolled 14 pediatric patients with drug HSRs who underwent drug desensitization between January 2020 and January 2024. The desensitization protocols used were developed by Castells and consisted of a 12-step protocol with 3 parenteral preparations with increasing concentrations. The standard protocol included premedication with antihistamine (pheniramine) and methylprednisolone (1 mg/kg) 30 minutes before the infusion.

Results: The study involved 14 patients. A total of 64 desensitizations were carried out for 16 different drugs. Only 13% resulted in mild to severe reactions. Overall, almost 92% of all desensitizations were successful. Additionally, it is important to highlight that all breakthrough reactions (BRs) occurred with monoclonal antibodies. Mild BRs during RDD were associated with more severe reactions during the next RDDs. No BRs were seen during RDD in patients with mild initial reactions.

Conclusion: It is important to note that desensitization is not an extreme method, and that pediatric age is not a contraindication. Desensitization is a safe and successful method for children, with a positive impact on survival and overall prognosis.

Keywords : Rapid drug desensitization, pediatric, drug allergy