TY - JOUR

T1 - Standards for practical intravenous rapid drug desensitization & delabeling

T2 - A WAO committee statement

AU - Madrigal-Burgaleta, Ricardo

AU - Alvarez-Cuesta, Emilio

AU - Broyles, Ana D.

AU - Cuesta-Herranz, Javier

AU - Guzman-Melendez, Maria Antonieta

AU - Maciag, Michelle C.

AU - Phillips, Elizabeth J.

AU - Trubiano, Jason A.

AU - Wong, Johnson T.

AU - Ansotegui, Ignacio

AU - Ali, F. Runa

AU - Angel-Pereira, Denisse

AU - Banerji, Aleena

AU - Berges-Gimeno, Maria Pilar

AU - Bernal-Rubio, Lorena

AU - Brockow, Knut

AU - Cardona Villa, Ricardo

AU - Castells, Mariana C.

AU - Caubet, Jean Christoph

AU - Chang, Yoon Seok

AU - Ensina, Luis Felipe

AU - Chikhladze, Manana

AU - Chiriac, Anca Mirela

AU - Chung, Weng Hung

AU - Ebisawa, Motohiro

AU - Fernandes, Bryan

AU - Garvey, Lene Heise

AU - Gomez, Maximiliano

AU - Gomez Vera, Javier

AU - Gonzalez Diaz, Sandra

AU - Hong, David I.

AU - Ivancevich, Juan Carlos

AU - Kang, Hye Ryun

AU - Khan, David A.

AU - Kuruvilla, Merin

AU - Larco Sousa, Jose Ignacio

AU - Latour-Staffeld, Patricia

AU - Liu, Anne Y.

AU - Macy, Eric

AU - Malling, Hans Jorgen

AU - Maspero, Jorge

AU - May, Sara M.

AU - Mayorga, Cristobalina

AU - Park, Miguel A.

AU - Peter, Jonathan

AU - Picard, Matthieu

AU - Rodriguez-Bouza, Tito

AU - Romano, Antonino

AU - Tanno, Luciana Kase

AU - Torres, Maria Jose

AU - Steering Committee Authors

AU - Review Panel Members

N1 - Publisher Copyright: © 2022 The Authors

PY - 2022/6

Y1 - 2022/6

N2 - Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients. Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, in vitro testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally. The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe. This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning care (including a specific supplemental section on a real-life example of how to design a dedicated space that can combine basic and complex diagnostic and therapeutic techniques in allergy).

AB - Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients. Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, in vitro testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally. The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe. This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning care (including a specific supplemental section on a real-life example of how to design a dedicated space that can combine basic and complex diagnostic and therapeutic techniques in allergy).

KW - Antibiotic desensitization

KW - Antibiotics

KW - Betalactams

KW - Biological agents

KW - Chemotherapy

KW - Delabeling

KW - Drug allergy

KW - Drug challenge

KW - Drug desensitization

KW - Drug provocation test

KW - Penicillins

KW - Personalized medicine

KW - Precision medicine

KW - Risk stratification

KW - Skin test

U2 - 10.1016/j.waojou.2022.100640

DO - 10.1016/j.waojou.2022.100640

M3 - Review

C2 - 35694005

AN - SCOPUS:85134599289

VL - 15

JO - The World Allergy Organization Journal

JF - The World Allergy Organization Journal

SN - 1939-4551

IS - 6

M1 - 100640

ER -