World Allergy Organization Journal (Jun 2022)
Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement
- 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
Affiliations
- Emilio Alvarez-Cuesta, MD, PhD, MQM
- Ramon y Cajal University Hospital, Madrid, Spain
- Ricardo Madrigal-Burgaleta, LMS, MD, PhD
- Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Drug Desensitisation Centre, Catalan Institute of Oncology (ICO), Barcelona, Spain; Corresponding author. Allergy & Severe Asthma Service, Respiratory Department, 4th Floor, King George V Building, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Ana D. Broyles, MD
- Division of Allergy & Immunology, Boston Children's Hospital, Boston, MA, USA
- Javier Cuesta-Herranz, MD, PhD
- Department of Allergy and Immunology, FIIS-Fundación Jiménez Díaz, UAM, Madrid, Spain; RETIC ARADyAL, Instituto de Salud Carlos III, Spain
- Maria Antonieta Guzman-Melendez, MD, PhD
- Section of Immunology, HIV and Allergy, Department of Medicine, Clinical Hospital University of Chile, Chile
- Michelle C. Maciag, MD
- Division of Allergy & Immunology, Boston Children's Hospital, Boston, MA, USA
- Elizabeth J. Phillips, MD
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Jason A. Trubiano, MBBS, PhD
- Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Australia
- Johnson T. Wong, MD
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Ignacio Ansotegui, MD, PhD
- Hospital Quironsalud Bizkaia, Bilbao-Erandio, Spain
- F. Runa Ali, MBBS, PhD, FRCP
- Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Denisse Angel-Pereira, MD
- Hospital Universitario de Canarias, Tenerife, Spain
- Aleena Banerji, MD
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Maria Pilar Berges-Gimeno, MD, PhD
- Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain
- Lorena Bernal-Rubio, MD
- Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain
- Knut Brockow, MD
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
- Ricardo Cardona Villa, MD
- Universidad de Antioquia, Medellín, Colombia
- Mariana C. Castells, MD, PhD
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Jean-Christoph Caubet, MD
- Pediatric Allergy Unit, Geneva University Hospitals, Geneva, Switzerland
- Yoon-Seok Chang, MD, PhD
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Luis Felipe Ensina, MD, MSc, PhD
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of Sao Paulo, Brazil
- Manana Chikhladze, PhD
- Medical Faculty at Akaki Tsereteli State University, KuTaisi, Tskaltubo, Georgia
- Anca Mirela Chiriac, MD, PhD
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Weng-Hung Chung, MD, PhD
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Linko and Keelung, Taiwan
- Motohiro Ebisawa, MD, PhD
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Bryan Fernandes, MBBS, MRCP
- Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Lene Heise Garvey, MD, PhD
- Allergy Clinic, Copenhagen University Hospital Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Maximiliano Gomez, MD, PhD
- School of Health Sciences, Catholic University of Salta, Argentina
- Javier Gomez Vera, MD
- Institute of Security and Social Services of State Workers, López Mateos Regional Hospital, Mexico City, Mexico
- Sandra Gonzalez Diaz, MD, PhD
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. José Eleuterio González”, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Mexico
- David I. Hong, MD
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Juan Carlos Ivancevich, MD
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
- Hye-Ryun Kang, MD, PhD
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- David A. Khan, MD
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Merin Kuruvilla, MD
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Jose Ignacio Larco Sousa, MD
- Allergy Department, Clinica San Felipe, Lima, Peru
- Patricia Latour-Staffeld, MD
- Centro Avanzado de Alergia y Asma de Santo Domingo, Santo Domingo, Dominican Republic
- Anne Y. Liu, MD
- Stanford University School of Medicine, Palo Alto, CA, USA
- Eric Macy, MD
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, San Diego Medical Center, San Diego, CA, USA
- Hans Jorgen Malling, MD
- Danish Allergy Centre, University of Copenhagen, Copenhagen, Denmark
- Jorge Maspero, MD
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
- Sara M. May, MD
- Division of Pulmonary, Critical Care, Sleep & Allergy, University of Nebraska Medical Center, Omaha, NE, USA
- Cristobalina Mayorga, PhD
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
- Miguel A. Park, MD
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
- Jonathan Peter, MBChB, PhD
- Division of Allergology and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Matthieu Picard, MD, FRCPC
- Department of Medicine, Division of Allergy and Immunology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
- Tito Rodriguez-Bouza, MD, PhD
- Centro de Patología Alérgica, Hospital Quirón Palmaplanas, Palma, Spain
- Antonino Romano, MD
- Oasi Research Institute – IRCCS, Troina, Italy
- Mario Sanchez-Borges, MD
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela; Allergy and Clinical Immunology Department, Clínica El Avila, Caracas, Venezuela
- Luciana Kase Tanno, MD, PhD
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Maria Jose Torres, MD, PhD
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
- Alicia Ureña-Tavera, MD
- Clinica Union Medica del Norte, Santiago, Dominican Republic
- Rocco L. Valluzzi, MD
- Multifactorial and Systemic Diseases Research Area, Predictive and Preventive Medicine Research Unit, Division of Allergy, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
- Gerald W. Volcheck, MD
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
- Masao Yamaguchi, MD, PhD
- Division of Respiratory Medicine, Third Department of Medicine, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan
- Journal volume & issue
-
Vol. 15,
no. 6
p. 100640
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).
