Nedelea Irena MD, PhD
University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca
Desensitization treatment of biological agents
Authors: Irena Nedelea, Diana Deleanu
Desensitization to drugs is indicated when they are indispensable to the therapeutic regimen in individuals with hypersensitivity reactions to the used drug. This implies the administration of progressively increasing doses of the incriminated drug until reaching the therapeutic dose in order to induce immunological tolerance.
Currently, drug desensitization is successfully used for antibiotics, aspirin, chemotherapeutic agents, as well as biological agents.
Desensitization is effective in individuals with immediate, IgE mediated hypersensitivity reactions, but data published in the literature support its efficacy in delayed type IV hypersensitivity reactions. Often, a drug induces adverse reactions mediated by different and complex immunological mechanisms. This category includes monoclonal antibodies. Adverse reactions to them deviate from the rule of hypersensitivity reactions as classified by Gell and Coombs. Because tolerance status is transient and maintained only in the context of daily drug administration, desensitization to biological agents at a different rate of administration, such as weekly, is a real challenge for both clinician and patient alike. Allergic reactions during desensitization remain a great obstacle. A better understanding of the pathological mechanisms of drug hypersensitivity reactions as well as those underlying desensitization are the premises for the success of this method.
This paper focuses on the topic of desensitization to biological agents and exposes the mechanisms by which immunological tolerance are induced, the protocol, indications, contraindications, possible adverse reactions and evolution after desensitization, along with the presentation of cases of desensitization to biological agents in the Department of Allergology of the “Professor Doctor Octavian Fodor” Regional Institute of Gastroenterology and Hepatology in Cluj-Napoca.