학술논문
Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement
Document Type
article
Author
Emilio Alvarez-Cuesta, MD, PhD, MQM; Ricardo Madrigal-Burgaleta, LMS, MD, PhD; Ana D. Broyles, MD; Javier Cuesta-Herranz, MD, PhD; Maria Antonieta Guzman-Melendez, MD, PhD; Michelle C. Maciag, MD; Elizabeth J. Phillips, MD; Jason A. Trubiano, MBBS, PhD; Johnson T. Wong, MD; Ignacio Ansotegui, MD, PhD; F. Runa Ali, MBBS, PhD, FRCP; Denisse Angel-Pereira, MD; Aleena Banerji, MD; Maria Pilar Berges-Gimeno, MD, PhD; Lorena Bernal-Rubio, MD; Knut Brockow, MD; Ricardo Cardona Villa, MD; Mariana C. Castells, MD, PhD; Jean-Christoph Caubet, MD; Yoon-Seok Chang, MD, PhD; Luis Felipe Ensina, MD, MSc, PhD; Manana Chikhladze, PhD; Anca Mirela Chiriac, MD, PhD; Weng-Hung Chung, MD, PhD; Motohiro Ebisawa, MD, PhD; Bryan Fernandes, MBBS, MRCP; Lene Heise Garvey, MD, PhD; Maximiliano Gomez, MD, PhD; Javier Gomez Vera, MD; Sandra Gonzalez Diaz, MD, PhD; David I. Hong, MD; Juan Carlos Ivancevich, MD; Hye-Ryun Kang, MD, PhD; David A. Khan, MD; Merin Kuruvilla, MD; Jose Ignacio Larco Sousa, MD; Patricia Latour-Staffeld, MD; Anne Y. Liu, MD; Eric Macy, MD; Hans Jorgen Malling, MD; Jorge Maspero, MD; Sara M. May, MD; Cristobalina Mayorga, PhD; Miguel A. Park, MD; Jonathan Peter, MBChB, PhD; Matthieu Picard, MD, FRCPC; Tito Rodriguez-Bouza, MD, PhD; Antonino Romano, MD; Mario Sanchez-Borges, MD; Luciana Kase Tanno, MD, PhD; Maria Jose Torres, MD, PhD; Alicia Ureña-Tavera, MD; Rocco L. Valluzzi, MD; Gerald W. Volcheck, MD; Masao Yamaguchi, MD, PhD
Source
World Allergy Organization Journal, Vol 15, Iss 6, Pp 100640- (2022)
Subject
Language
English
ISSN
1939-4551
Abstract
Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients.Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, in vitro testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally.The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe.This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning care (including a specific supplemental section on a real-life example of how to design a dedicated space that can combine basic and complex diagnostic and therapeutic techniques in allergy).