Evaluating Safety and Efficacy Protocols of Graded Dose Challenge and Desensitization

Killian Meara

Killian Meara, assistant editor for ContagionLive, joined the MJH Life Sciences team in November 2020. He graduated from William Paterson University with a degree in liberal studies, and concentrations in history and psychology. He enjoys film, reading, and pretending he is a good cook. Follow him on Twitter @krmeara or email him at [email protected]

GDC and DSENS were both seen to be safe and effective tools to optimize therapy in the study participants.

Although 10% of patients report having an allergy to an antibiotic, many are still able to take the medication or one similar. Attempts to initiate early, optimal therapy should be made in patients with documented antibiotic allergies to avoid inferior clinical outcomes, higher risk of adverse events, and increased length of hospital stay.

Two strategies which can be implemented in patients with a reported allergy are graded dose challenge (GDC) and desensitization (DSENS). Graded dose challenge assesses a patient’s ability to tolerate a therapy or a related one, while desensitization provides the ability to administer a drug (or related drug) despite a convincing IgE-mediated allergy.

However, ordering and administration operational and safety challenges have the potential to limit the use of these 2 strategies.

Recently, investigators from Atrium Health, in collaboration with the University of North Carolina Eshelman School of Pharmacy, have conducted an evaluation to determine the safety and efficacy of protocols for GDC and DSENS.

The data was presented at the 23rd Annual Making a Difference in Infectious Disease Meeting 2021 virtual sessions.

The single health-system, multicenter, retrospective evaluation included 76 participants who were receiving a GDC or DSENS for an antibiotic between February 1, 2019, and September 30, 2020. The primary objective of this study was to determine the proportion of patients undergoing GDC and DSENS who tolerated a full dose of the target antibiotic.

Of the 76 patients in the evaluation, 58 met inclusion criteria, 50 for GDC and 8 for DSENS.

Findings from the evaluation showed that of the 50 patients receiving GDC, 45 (90%) tolerated a full antibiotic dose and 44 (88%) tolerated a full course. The 8 patients receiving DSENS tolerated the procedure and full target antibiotic course.

Additionally, 5 of the patients required rescues medications, 4 in the GDC group and 1 in the DSENS group, but none of them had any prolonged complications.

“Used under the guidance of ASP pharmacists or ID physicians, antibiotic GDC and DSENS are safe and effective tools to optimize therapy in patients who report an IgE-mediated antibiotic allergy,” the authors wrote.