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Article Dans Une Revue World Allergy Organization Journal Année : 2022

Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

1 Hospital Universitario Ramón y Cajal [Madrid]
2 St Bartholomew's Hospital (London)
3 Barts Health NHS Trust [London, UK]
4 ICO - Catalan Institute of Oncology = Instituto Catalán de Oncología
5 Boston Children's Hospital
6 HMS - Harvard Medical School [Boston]
7 Fundación Jiménez Díaz
8 RETIC ARADyAL
9 University of Chile Clinical Hospital
10 Boston Children's Hospital
11 Vanderbilt University Medical Center [Nashville]
12 University of Melbourne
13 Massachusetts General Hospital [Boston]
14 Hospital Quirónsalud Bizkaia [Bilbao]
15 Hospital Universitario De Canarias
16 TUM - Technische Universität Munchen - Technical University Munich - Université Technique de Munich
17 Universidad de Antioquia = University of Antioquia [Medellín, Colombia]
18 HUG - Hôpitaux Universitaires de Genève
19 SNUBH - Seoul National University Bundang Hospital
20 SNU - Seoul National University [Seoul]
21 Unifesp - Federal University of Sao Paulo
22 Akaki Tsereteli State University
23 IDESP - Institut Desbrest de santé publique
24 Service d'allergologie et de pneumologie [Hôpital Arnaud de Villeneuve]
25 CGMH - Chang Gung Memorial Hospital [Taipei]
26 Sagamihara National Hospital [Kanagawa, Japan]
27 Copenhagen University Hospital
28 ITU - IT University of Copenhagen
29 Catholic University of Salta
30 ISSSTE - Regional Hospital Lic. Adolfo Lopez Mateos
31 Hospital Universitario Dr. José Eleuterio González
32 BWH - Brigham & Women’s Hospital [Boston]
33 Clinica Santa Isabel - Servicio de Alergia e ImmunologiaBuenos Aires
34 SNUCM - Seoul National University College of Medicine [Séoul, Corée du Sud]
35 University of Texas Southwestern Medical Center [Dallas]
36 Emory University School of Medicine
37 Clinica San Felipe
38 Centro Avanzado de Alergia y Asma de Santo Domingo
39 Stanford University
40 University of California Medical Center [San Diego]
41 Fundación Cidea Allergy and Respiratory Research Unit,
42 University of Nebraska Medical Center
43 Hospital Regional Universitario de Málaga = Regional University Hospital of Malaga [Spain]
44 National Network ARADyAL - Allergy Unit [Malaga, Spain]
45 Mayo Clinic [Rochester]
46 University of Cape Town
47 Hôpital Maisonneuve-Rosemont
48 Centro de Patología Alérgica
49 Oasi Maria Santissima Srl [Troina, Italy]
50 Centro Médico Docente La Trinidad
51 Clínica Unión Medica del Norte
52 IRCCS Ospedale Pediatrico Bambino Gesù = Bambino Gesù Children’s Hospital
53 Chiba University Hospital
Anne Liu
  • Fonction : Auteur

Résumé

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).
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hal-03778479 , version 1 (19-09-2022)

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Emilio Alvarez-Cuesta, Ricardo Madrigal-Burgaleta, Ana Broyles, Javier Cuesta-Herranz, Maria Antonieta Guzman-Melendez, et al.. Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement. World Allergy Organization Journal, 2022, 15 (6), pp.100640. ⟨10.1016/j.waojou.2022.100640⟩. ⟨hal-03778479⟩
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