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Protocols for Drug Allergy Desensitization

Protocols for Drug Allergy Desensitization

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drug allergy, desensitization, protocol, protocols for drug allergy desensitization
drug allergy, desensitization, protocol, protocols for drug allergy desensitization

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Published by: Timothy j. Sullivan, III, MD on Nov 03, 2009
Copyright:Attribution Non-commercial

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04/04/2013

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Protocols for Rapid and Slow Drug AllergyDesensitization
First EditionNovember, 2009ByTimothy J. Sullivan, M.D.Atlanta, Georgia
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Introduction
This short monograph is a compilation of representative protocols that have been used in our clinicsto desensitize patients who met generally accepted criteriafor a diagnosis of drug allergy. The purpose of presentingthis information is to facilitate the design of protocols for use by other clinicians or investigators.Approaches to patient specific diagnosis of drugallergy, assessment of relative risks, decisions about premedication, and other patient specific factors crucial tosuccessful use of these protocols is beyond the scope of thismonograph.
Rapid desensitization
protocols have been usedto allow use of medications in patients with IgE-mediatedsensitivity to medications. The mechanism seems to be primariy acute antigen-specific mast cell desensitization.The general principles are to initiate desensitization withlow microgram amounts of drug, doubling the dose every15 minutes, and then careful observation for 2 hours after the administration of the last dose. Individual patients mayrequire lower starting doses and longer intervals betweendoses. Representative oral desensitization and intravenousdesensitization protocols are presented. Code 95180 per hour of the procedure to the nearest hour.
Slow desensitization
protocols are used for management of patients with drug allergy involving
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mechanisms other than antigen-specific IgE. The bestevidence at the moment is that gradually increasing dosesallow metabolic adaptation to increasing need to clear reactive drug metabolites. This efficient metabolism of thedrug minimizes the formation of the haptenated carrier molecules that induce immune responses and elicit allergicreactions. This process would not be expected to work with complete antigens such as insulin or aminoglycosides.Regardless of mechanism, the principles are to start at alow dose and increase over one to four weeks or more toreach therapeutic doses. Approximately 15% of patientswill not be controlled with a one or two week protocol andmay need slower increases in doses.
Modifications of the protocols
to accommodate patientand drug issues are common in the published literature. Aslong as starting doses are low microgram doses, or lower,and the intervals between doses of antigen administrationare not shortened the mast cell desensitization or metabolicadaptation has been reported to be successful with a widevariety of drug antigens.
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