Desensitization in children allergic to drugs: Indications, protocols, and limits

Abstract

Any drug can potentially induce a hypersensitivity reaction. If after the allergological work-up the drug hypersensitivity reaction is confirmed, in most cases, the simple avoidance of the culprit drug and a suggestion of an unrelated alternative is enough.However, there are circumstances where the choice to stop the treatment affects the survival, the safety and/or the quality of life of the patient and the global outcome of the disease in question. When this occurs, drug desensitization can be the answer and should not be viewed as an extravagance, nor the pediatric age should be considered a contraindication. Drug desensitization in children can be safely and successfully performed, having a positive impact on the survival and overall prognosis. In general, the indications for DDS are the same in adults as in children. However, in this age group there are specificities that this paper aimed to describe, reviewing the mechanisms behind drug hypersensitivity and rapid drug desensitization, types of protocols, indications, and contraindications, as well as several technical aspects that are specific to the pediatric age.

Drug-Induced Anaphylaxis in Children

“…The decision to proceed with desensitization should consider the potential risks and benefits for the individual child, as well as his/her medical history and current health status. Desensitization protocols in the pediatric population have mainly been studied for antibiotics, such as beta-lactams, and chemotherapy for young children with solid tumors [ 63 ]. In particular, children and adolescents with cystic fibrosis have a propensity for infections, most notably caused by Pseudomonas aeruginosa.…”

“…Because of frequent and repeated exposures to antibiotics, cystic fibrosis patients have a prevalence of up to 70% of allergic reactions and a high risk for potentially life-threatening reactions to antibiotics, especially beta-lactams, with a frequent need for desensitization procedures [ 64 , 65 ]. There is a need for more extensive research and documentation to cover a broader range of drugs, including mAbs, which are increasingly used [ 63 ]. Desensitization protocols for rituximab, infliximab, and tocilizumab in children have been successfully described in various studies [ 66 , 67 , 68 , 69 , 70 ].…”