Chemotherapy and Biologic Drug Allergy

Abstract

With increased utilization of chemotherapeutic agents and monoclonal biological agents for the treatment of malignancies, autoimmune diseases, and allergic diseases, the incidence of adverse reactions secondary to the usage of the agents is expected to increase. In evaluating a patient with adverse reaction to the agents, obtaining a history is the most important step to define the mechanism. Type A adverse drug reaction is expected side effect of the drug. Type B reaction can be systemic inflammatory response syndrome or immediate hypersensitivity. If the adverse drug reaction is an immediate hypersensitivity reaction by history, diagnostic test like elevation of serum tryptase level within 4 h of the reaction may be important to prove that the reaction is an immediate hypersensitivity. Skin testing if positive may also help to confirm the diagnosis of type I reaction. If the reaction is immediate hypersensitivity, rapid drug desensitization can be utilized to induce a state of temporary tolerance so that the patient can continue to receive the agent which is critical for his or her survival and quality of life. Desensitization protocols have been described and are similar to penicillin desensitization protocols. If carefully implemented, the procedure is effective with reasonable benefit to risk ratios. Attachment B and Attachment D are two spread sheets for intravenous desensitization and subcutaneous desensitization, that a licensed physician, who specializes in drug desensitization, can utilize to conveniently write the order for the desensitization procedure.