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Hypersensitivity Reactions to Cancer Chemotherapy: Practical Recommendations of ARADyAL for Diagnosis and Desensitization

Vega A1,2,3*, Jimenez-Rodriguez TW2,4*, Barranco R2,5, Bartra J2,6, Diéguez MC2,5, Doña I2,7,8, Fernández-Rivas M2,9, Gandolfo-Cano M2,10, Gastaminza-Lasarte G2,11, González-Mancebo E2,10, de la Hoz Caballer B2,12,13, Sánchez-Morillas L2,9, Torres MJ2,7,8, Berges-Gimeno MP2,12†, Muñoz-Cano R2,6†

1Allergy Department. Hospital Universitario de Guadalajara, Spain
2ARADyAL Spanish network (RD16/0006). Instituto de Salud Carlos III (ISCIII). Fundación Española para la Ciencia y la Tecnología (FECyT), Madrid. Spain
3Facultad de Medicina, Universidad Internacional de Cataluña
4Allergy Section, Alicante General University Hospital-ISABIAL. Alicante, Spain
5Allergy Department. Hospital Universitario 12 de Octubre. Madrid,Spain. i+12
6Allergy Section, Pneumology Department, Hospital Clinic, Universitat de Barcelona. IRCE- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
7Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA. Hospital Civil, Málaga, Spain
8Allergy Unit, Hospital Regional Universitario de Málaga. Hospital Civil, 29009 Málaga, Spain
9Servicio de Alergia. Hospital Clínico San Carlos. IdISSC. UCM. Madrid, Spain
10Allergy Department. Hospital Universitario de Fuenlabrada. Madrid, Spain. IdiPAZ
11Allergy Department. Clínica Universidad de Navarra. Pamplona, España
12Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain. IRYCIS
13Universidad de Alcalá. Madrid, Spain

J Investig Allergol Clin Immunol 2021; Vol. 31(5)
doi: 10.18176/jiaci.0712

Rapid drug desensitization (RDD) has allowed first line therapies in patients with drug hypersensitivity reactions (DHR) to chemotherapeutic drugs (ChD) including monoclonal antibodies (mAb). Desensitization is a safe and highly effective procedure, not only for IgE-mediated reactions but also for those mediated by non-IgE mechanisms. The likelihood of breakthrough reactions (BTR) during desensitization is low and, most are mild; in fact moderate to severe reactions are infrequent.
In this document, sixteen Allergy Departments belonging to the ARADyAL Spanish research network present a review of the available scientific evidence and provide general guidelines for the diagnosis and management of DHR to ChD and mAb, focusing on the desensitization procedure.

Key words: Drug allergy, Drug hypersensitivity, Desensitization, Chemotherapy, Drug challenge, Monoclonal antibodies