Same-day desensitization linked to lower breakthrough reaction rate than rapid protocol in chemotherapy hypersensitivity

BackgroundRapid drug desensitization (RDD) allows first-line treatment to continue after a hypersensitivity reaction to the antineoplastic agent. There are different desensitization procedures, and none of them are free from breakthrough reactions (BTR).ObjectivesThe objective of the study is to evaluate and compare the efficacy of different desensitization procedures, considering the effect of a series of confounding variables, and to describe the characteristics of BTRs in different procedures.MethodsA retrospective, comparative review of medical records from patients who experienced hypersensitivity reactions to platinum- or taxane-based chemotherapy was conducted. Patients were categorized into two groups; rapid drug desensitization (RDD) and same-day desensitization (SDD), according to the intervention performed on the day of the initial reaction. Demographic data, drug, retreatment, cancer type, phenotype and severity of the initial reaction, allergy testing, number of desensitizations performed, outcome of desensitizations, and number, phenotype and severity of BTRs were recorded according to group.ResultsIn the RDD group, 406 desensitizations were analyzed in 76 subjects with a BTR rate of 24%. In the SDD group, 164 desensitizations were analyzed in 44 subjects with a BTR rate of 15%. A marginaleffects analysis using a Bayesian hierarchical model showed a 14.6-point reduction in the probability of BTR in the SDD group.ConclusionThis study confirms that desensitization procedures are safe and effective and allows us to conclude, based on the data and the model, that the SDD group has a lower probability of BTR than the RDD group.