Importance of Diagnostics Prior to Desensitization in New Drug Hypersensitivity: Chemotherapeutics and Biologicals

  • Ricardo Madrigal-BurgaletaEmail author
  • P. Vazquez-Revuelta
  • J. Marti-Garrido
  • R. Lleonart
  • F. R. Ali
  • Emilio Alvarez-Cuesta
Drug Allergy (C Mayorga, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Drug Allergy
  2. Topical Collection on Drug Allergy


Purpose of review

In this review article, we intend to summarize the diagnostic tools available for the study of drug hypersensitivity reactions to chemotherapy and biologicals, based on the experience and controversies of the main research groups leading the topic.

Recent findings

Recent publications with large cohorts of patients reacting to these drugs are allowing for a better understanding of phenotyping, endotyping, and optimally managing these patients.


There is a remarkable heterogeneity on the diagnostic and therapeutic approach among the different groups, and yet this has allowed for very interesting discoveries. Clinical history alone is insufficient for a diagnosis, but in vitro and in vivo biomarkers are essential for personalized management plans and precision medicine. Drug provocation testing is an essential tool and criterion standard. Despite heterogeneity, dedicated multidisciplinary drug desensitization program/unit, with dedicated space and personnel for their activities, have shown to be the optimal approach. In this acticle, we provide detailed information on diagnostics tools, with an specific focus on drug provocation testing. Looking forward, collaboration, standardization of techniques, and generalization of solidly established drug allergy teams in large hospitals are fundamental steps for the specialty of allergy in the twenty-first century.


Drug allergy Desensitization Skin test Drug provocation test Chemotherapy Biologicals 


Compliance with Ethical Standards

Conflict of Interest

Ricardo Madrigal-Burgaleta, Paula Vazquez-Revuelta, Jaume Marti-Garrido, Ramon Lleonart, Runa Ali, and Emilio Alvarez-Cuesta declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ricardo Madrigal-Burgaleta
    • 1
    Email author
  • P. Vazquez-Revuelta
    • 2
  • J. Marti-Garrido
    • 2
  • R. Lleonart
    • 2
  • F. R. Ali
    • 1
  • Emilio Alvarez-Cuesta
    • 3
  1. 1.St Bartholomew’s Hospital, Barts Health NHS TrustAllergy & Severe Asthma ServiceLondonUK
  2. 2.Programa de Dessensibilització ICO-HUBUnitat d’Al·lergologia, Hospital Universitari de Bellvitge, IDIBELLBarcelonaSpain
  3. 3.Allergy DivisionRamon y Cajal University HospitalMadridSpain

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