Desensitization

Desensitization, or temporary induction of drug tolerance, is used for patients with a documented or convincing history of type-1 immediate (IgE-mediated) beta-lactam allergy and/or positive skin test and a serious infection where non-cross-reacting alternatives are not appropriate.

The goal of desensitization is to modify a patient’s immune response to allow safe treatment with the allergenic drug.

Desensitization will not prevent non-IgE mediated reactions and should never be attempted in patients with reactions involving major organs or severe cutaneous reactions (e.g. interstitial nephritis, SJS, TEN, DRESS, etc.).

Desensitization is performed by administering incremental doses of the allergenic drug.

Usually the procedure is complete within hours and starts in the microgram range.

Dosages are usually doubled every 15 to 30 minutes until therapeutic doses are achieved.

When the desensitization process is complete, treatment with the select beta-lactam should be started immediately and must not be interrupted during the treatment course.

Desensitization is usually lost within two days of cessation and must be repeated if the beta-lactam is required in the future.