Safety, Costs, and Efficacy of Rapid Drug Desensitizations to Chemotherapy and Monoclonal Antibodies

David Sloane, Usha Govindarajulu, Jacob Harrow-Mortelliti, William Barry, Florence Ida Hsu, David Hong, Tanya Laidlaw, Ross Palis, Henry Legere, Supinda Bunyavanich, Rebecca Breslow, Duane Wesemann, Nora Barrett, Patrick Brennan, Hey Jin Chong, Anne Liu, James Fernandez, Laura Fanning, Timothy Kyin, Katherine CahillLora Bankova, Ashly Lynch, Suzanne Berlin, Susana Campos, Charles Fuchs, Robert Mayer, Ursula Matulonis, Mariana Castells

Research output: Contribution to journalArticlepeer-review

154 Scopus citations


Background: Rapid drug desensitization (RDD) is used to address hypersensitivity reactions to chemotherapeutics and monoclonal antibodies, allowing patients to be treated with optimal pharmacological agents. RDD protocols are tailored to each individual patient's reaction and needs, and protect against anaphylaxis, but overall risks, costs, and benefits have not been determined. Objective: We investigated the safety, efficacy, costs, and life expectancy of patients in a large population undergoing RDD. Methods: We analyzed 2177 RDD procedures performed in 370 patients with cancer, vasculitis, and hematological and connective tissue diseases who presented 402 reactions. A subgroup of carboplatin allergic patients with ovarian cancer treated with RDD was analyzed for costs and life expectancy and compared with a nonallergic control group. Results: RDD allowed all patients to receive safely the full dose of the medication to which they were reactive. A gradual increase in the fraction of outpatient desensitizations from 81% to 98% was achieved through risk stratification. Of the 2177 desensitizations, 93% had no or mild reactions whereas 7% had moderate to severe reactions, which did not preclude the completion of the treatment, and there were no deaths. Overall health costs in the carboplatin allergic group were not higher than those in the nonallergic group treated with standard of care. Administration of carboplatin through RDD was as effective as standard administration with a nonsignificant increase in life expectancy in desensitized patients as compared with nonallergic, nondesensitized controls. Conclusions: RDD is cost effective and safe for allergic patients with cancer and chronic disease to remain on first line therapy.

Original languageEnglish
Pages (from-to)497-504
Number of pages8
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number3
StatePublished - 1 May 2016
Externally publishedYes


  • Carboplatin
  • Chemotherapeutic agents
  • Cost
  • Drug desensitization
  • Drug hypersensitivity
  • Efficacy
  • Monoclonal antibodies
  • Safety


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