A Successful Shortening of Desensitization Protocol in a Patient with Cetuximab Anaphylaxis
Keywords:
Anaphylaxis, Cetuximab, Desensitization, Immunologic toleranceAbstract
Desensitization therapy can help overcome severe hypersensitivity reactions and allow continuing administration of the culprit agents. However, this is time-consuming and labor-intensive due to a prolonged infusion time and the serial adjustment of infusion rate at different periods. Therefore, simplified protocols using fewer steps have been tested, although currently there is no established standard strategy. Cetuximab plays an important role in the treatment of metastatic colorectal cancer. Although cetuximab is well tolerated, severe infusion reactions occur in 1.1% of patients, and most occur within 1 hour of receiving the first dose. Here, we report a recent attempt to shorten the steps of gradual cetuximab desensitization. A 57-year-old male patient diagnosed with obstructive sigmoid colon cancer received cetuximab chemotherapy and experienced immediate anaphylaxis in the first cycle. A one-bag, 17-step desensitization protocol was applied to cetuximab administration. After the first successful desensitization cycle, the process of desensitization was shortened by 1–2 step(s) per cycle, down to 2 steps, without a breakthrough reaction.The patient ultimately received regular infusions. Shortening of the rapid desensitization protocol can be considered if the previous cycle is well-tolerated,even in a patient who has suffered anaphylaxis due to cetuximab.
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