When patients with life-threatening bacterial infections are allergic to antibiotics, drug desensitization may be an option when no other alternative exists according to a report published this month in Annals of Allergy, Asthma & Immunology
, the scientific journal of the American College of Allergy, Asthma and Immunology
Stuart E. Turvey, M.B., B.S., D.Phil., and colleagues at Children’s Hospital in Boston, retrospectively reviewed the medical records of all patients undergoing antibiotic desensitization at their institution during a 5-year period between 1996 to 2001, in what they describe is the largest combined series of antibiotic desensitization outcomes published to date.
The investigators compiled and analyzed data on 57 desensitizations performed in 21 patients, 19 of whom had been diagnosed as having cystic fibrosis. Patients with cystic fibrosis, who during their lifetime receive multiple courses of antibiotics, may be predisposed to allergic sensitization against a range of antibiotics.
Desensitization allows safe delivery of an antibiotic to a patient who has an IgE-mediated sensitivity to that drug by administering it in small doses until a full therapeutic dose is clinically tolerated. The procedure entails risk of acute allergic reactions, including death, and authors recommend it be performed only in a controlled inpatient setting.
Turvey and his team reported that desensitizations were performed to 12 different antibiotics, with successful outcomes in 75 percent. Of the 11 cases that were terminated due to an allergic reaction, there were no fatalities, intubations, or other aggressive interventions besides the use of epinephrine, antihistamines and corticosteroids. In 7 of 11 unsuccessful desensitizations, a non-IgE mechanism appeared to be responsible for the allergic reaction.
The report outlines the process involved in selecting a candidate for antibiotic desensitization and presents standard protocols for desensitization for a range of common antibiotics used in cystic fibrosis patients.
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