A safe protocol for rapid desensitization in patients with cystic fibrosis and antibiotic hypersensitivity

Abstract

Background CF patients often demonstrate hypersensitivity to one or multiple antibiotics due to frequent and repeated exposures. Attempts at antibiotic desensitization in this population are historically complicated by higher reaction rates, failure to complete the procedure and consequent withholding of first-line therapy. This study evaluates the outcomes of a rapid desensitization protocol developed at our institution. Methods We retrospectively reviewed the medical records of 15 patients undergoing 52 rapid antibiotic desensitizations at Brigham and Women’s Hospital and Children’s Hospital Boston utilizing our protocol. Results Mean FEV1 % predicted was 44.1 (SD 16.5), with two patients at <30% and one patient desensitized during bilateral lung transplantation. Adverse reactions during desensitization occurred in 13.4%, and most were mild. 100% of patients completed the protocol and ultimately tolerated subsequent full-strength antibiotic courses. Conclusions CF patients with antibiotic hypersensitivity can safely receive first-line antibiotics via our rapid desensitization protocol, including those with severe obstructive lung disease.

Pattern of inpatient referrals to a drug allergy unit in Kuwait

“…There were only six referrals for desensitization during the period of this study, and none of them were for chemotherapeutics, antibiotics or monoclonal antibodies. This was an interesting and rather unexpected finding, particularly given the wealth of evidence supporting good safety and efficacy profiles (20,21). The field of drug allergies relies almost entirely on referrals from physicians from other specialties and general practitioners.…”

Revealing the dynamics of polymicrobial infections: implications for antibiotic therapy

“…It is therefore vital for the long-term health of this patient group to ensure that an effective intervention is made to limit as much as possible the resulting damage to the airways. Further, as the life expectancy of CF patients increases, the significance of side effects that result from repeated antibiotic treatments, particularly renal impairment [37], ototoxicity [38], and increased risk of drug reactions [39], becomes even more important. When combined with the importance of minimizing the impact of bacterial resistance to antibiotics, there is a clear need for antibiotics to be administered as efficiently as possible.…”

Successful desensitization to cloxacillin in a patient with sepsis, with infective endocarditis and clinical suspicion of hypersensitivity to penicillins, a case report

“…DS is a safe and effective process, and it has been described as a safe process in more than 90% of the cases . However, it is a complex process indicated in specific situations that must be carried out by a multidisciplinary team led by an allergist.…”

“…Cloxacillin dose and concentrations are given in Table . This protocol is a modification of the DS model proposed by Legere et al in 2009 . We prepared the dilutions using aseptic techniques.…”