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

Vega A1,2,3*, Jimenez-Rodriguez T-W2,4*, 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, 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, Barcelona, Spain
4Allergy Section, Alicante General University Hospital-ISABIAL, Alicante, Spain
5Allergy Department, Hospital Universitario 12 de Octubre and i+12, Madrid, Spain
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, Málaga, Spain
9Servicio de Alergia, Hospital Clínico San Carlos, IdISSC, UCM, Madrid, Spain
10Allergy Department, Hospital Universitario de Fuenlabrada, Fuenlabrada and IdiPAZ, Madrid, Spain
11Allergy Department, Clínica Universidad de Navarra, Pamplona, Spain
12Allergy Department, Ramon y Cajal University Hospital and IRYCIS, Madrid, Spain
13Universidad de Alcalá, Madrid, Spain
*Arantza Vega and Teodorikez-Wilfox Jimenez-Rodriguez should be considered joint first authors.
**María Pilar Berges-Gimeno and Rosa Muñoz-Cano should be considered joint last and corresponding authors.

J Investig Allergol Clin Immunol 2021; Vol 31(5) : 364-384
doi: 10.18176/jiaci.0712

Rapid drug desensitization has enabled first-line therapies in patients with drug hypersensitivity reactions to chemotherapeutic drugs including monoclonal antibodies. 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 during desensitization is low, and most are mild; in fact, moderate-to-severe reactions are infrequent.
In this document, 16 allergy departments belonging to the Spanish research network ARADyAL present a review of the available scientific evidence and provide general guidelines for the diagnosis and management of drug hypersensitivity reactions to chemotherapeutic drugs and monoclonal antibodies. Emphasis is placed on the desensitization procedure.

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