Drug desensitisation (rapid desensitisation to anticancer drugs)

Desensitisation induces temporary tolerance to a drug allergen so that a first-choice drug can be continued after a hypersensitivity reaction. In the series by Castells and colleagues (2008), 98 patients who had reacted to carboplatin, cisplatin, oxaliplatin, paclitaxel, liposomal doxorubicin, doxorubicin or rituximab received 413 desensitisations with a standardised 12-step protocol, intravenously or intraperitoneally; 94% induced mild or no reactions, there were no life-threatening reactions or deaths, all patients received their full target dose, and most reactions occurred at the last step. The EAACI position paper (2022) notes that platinum compounds, taxanes, epipodophyllotoxins and asparaginase cause most chemotherapy hypersensitivity reactions, and covers skin tests, drug provocation tests and desensitisation in its recommendations. The tolerance is temporary, so the procedure is repeated for each course.