# Rapid drug desensitisation after an allergic reaction to a platinum, taxane or antibody

Source: https://onco.cc/protocols/drug-desensitisation-after-anticancer-hypersensitivity/  
OnCo record `drug-desensitisation-after-anticancer-hypersensitivity` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

If you have had a true allergic reaction to a cancer drug that is still your best treatment, allergy specialists can often give it again safely by desensitisation: starting with a tiny, very diluted dose and building up slowly over several hours, under close watch. The protection lasts only while the drug is in your body, so it is repeated at every treatment.

## Summary

After a hypersensitivity reaction, the choices are desensitisation, skin testing to stratify risk, risk stratification and a drug challenge without testing, or avoiding the drug if an equally effective alternative exists (AAAAI/ACAAI practice parameter 2022). The first task is phenotyping: non-IgE reactions to chemotherapy or biologics can be managed with slower infusion, graded dose escalation or premedication without desensitisation (a conditional suggestion), while candidates for desensitisation include type I (mast-cell or IgE-mediated) reactions, including anaphylaxis. Empiric desensitisation is described as reasonable and safe even without skin testing; for platinums, skin testing can stratify risk and show when desensitisation is unnecessary; for antibodies it should be considered when the drug is the preferred therapy.

Oncology guidance is more cautious. ESMO (2017) says rechallenge after a CTCAE grade 3 or higher reaction or true anaphylaxis should not be attempted [V, B], and that desensitisation has been used for some drugs with varying success in experienced centres, with no standard protocol. The method gives an initial small, diluted dose over a prolonged infusion with gradual escalation; tolerance is temporary, so it is repeated at every course. The best-known protocol, a standardised 12-step, three-bag regimen, gave 413 desensitisations in 98 patients with 94% mild or no reactions and no deaths. One-bag protocols appear similarly safe, with less data after severe reactions. In 241 women with gynaecological cancers, survival after desensitisation for platinum or taxane reactions was comparable to that without reactions.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: chemotherapy desensitization; rapid drug desensitisation; RDD; carboplatin desensitisation; paclitaxel desensitisation; 12-step desensitization; 3-bag protocol; rituximab desensitisation; carboplatin allergy

## Connected records

- protocols: [Infusion and hypersensitivity reactions during anticancer treatment: recognition, emergency treatment and rechallenge](https://onco.cc/protocols/infusion-reaction-management/), [Premedication against infusion reactions before taxanes, antibodies and other reaction-prone anticancer drugs](https://onco.cc/protocols/premedication-before-reaction-prone-anticancer-drugs/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Rituximab](https://onco.cc/drugs/rituximab/)
- terms: [Infusion reactions, hypersensitivity and extravasation](https://onco.cc/terms/extravasation-infusion-reaction/)

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