Adrenaline: A Lifeline for Rapid Drug Desensitization in Hypersensitive
Patients.
Abstract
Background: Chemotherapy (CHT) and monoclonal antibodies (mAbs)
have been described as frequent causes of drug allergy. Currently, rapid
drug desensitization (RDD) is a widely recognized and safe procedure
extensively used to manage patients with drug hypersensitivity reactions
(DHR). Nevertheless, despite its effectiveness, RDD can occasionally be
hampered by severe breakthrough reactions (BTR) during the procedure,
potentially leading to its failure. Objective: Evaluate the
usefulness and safety of adrenaline infusion (AI) as a coadjuvant during
RDD in patients with severe DHR during standard desensitization
protocols. Methods: Retrospective observational study,
analyzing data from patients who underwent RDD to CHT or mAbs in a
tertiary hospital from January-2015 to January-2024. We included
patients who required the use of AI to safely achieve RDD after a severe
initial DHR or failure of standard RDD protocol due to repeated DHR.
Comorbidities, adrenaline doses and adverse events (AE) were
assessed. Results: Forty-two patients met the inclusion
criteria. Seventy-seven percent ( n=32) were women with a mean
age of 57 years(range 32-83). Most frequent drugs involved in DHR were
platinum-salts 58%, mAbs 26% and taxanes 14%. A total of 151 RDD were
performed with coadjuvant AI. Skin tests were positive in 69% of
patients. The most frequent initial BTR (65%, n=28) was moderate
or severe anaphylaxis. The most common adverse events (AE) associated
with AI were trembling and tachycardia (14% and 7% respectively).
These symptoms subsided after reducing the AI infusion rate. The median
cumulative dose of adrenaline administrated during the entire RDD
procedure was 0.76µg(IQR 0.4-1.2µg SD 3.05), with a median infusion rate
of 8ml/h(IQR 4-15ml/h), and median AI maximum rate of 3.33µg/min(IQR
2-5.3µg/min). Conclusions: AI is a useful and safe
therapeutic tool for selected high-risk desensitization procedures,
contributing to mitigate severe DHR with mostly minor AE.