Safety and Outcomes of Rapid Drug Desensitization to Various Biologic Agents: A Multidisciplinary Experience
Articles > Article · 2026
Authors: Kutay Kirdok, Elif ERTUNA, Umitcan Ates, Zuleyha Galata, Meryem Senturk, Ragip Kural, Ecem Ay, Eda Aslan, Turkan Canbaz, Reyhan Gumusburun, Emine Mete Gokmen, Aytul Sin, Ceyda TUNAKAN DALGIÇ
Journal of Asthma and Allergy, International, WoS, 2026, vol Volume 19, pp 1-10
DOI: 10.2147/jaa.s578075
Summary
Background: Biologic agents are widely used in clinical practice, but hypersensitivity reactions (HSRs) may limit their use. Rapid drug desensitization (RDD) allows patients to safely continue essential therapy by inducing temporary tolerance, but evidence on newer biologics such as daratumumab, brentuximab vedotin, and pertuzumab remains scarce. Methods: We retrospectively reviewed 11 patients who underwent RDD for biologic-induced HSRs between 2020 and 2024 at a tertiary allergy center. Each protocol was jointly designed by an experienced allergist and clinical pharmacist and carried out in the intensive care unit under close nurse and physician supervision. Demographic, clinical, and laboratory data, reaction grades, skin test results, premedication regimens, and breakthrough reactions (BTRs) were analyzed. Results: A total of 43 RDD cycles were performed for rituximab (n = 18), brentuximab vedotin (n = 13), daratumumab (n = 9), and pertuzumab (n = 3). Six patients underwent skin testing, two with positive results. Four patients (36%) experienced only mild cutaneous BTRs during their first RDD cycle, and no severe events occurred. The overall BTR rate per cycle was 9.3%. Extending premedication to more than 24 hours before desensitization reduced BTR frequency from 17% to 4%. Conclusion: RDD proved to be a safe and effective approach for managing HSRs to both common and less frequently used biologic agents. All patients completed treatment without discontinuation. Extended premedication period, multidisciplinary planning, and intensive care unit-based monitoring appear to enhance procedural safety and support the broader implementation of RDD in clinical allergy practice. Plain Language Summary: Biologic drugs are important treatments for many immune, blood, and cancer-related diseases. However, some patients develop allergic or hypersensitivity reactions that prevent them from continuing these medicines. RDD is a medical procedure that allows patients to safely receive a medication that previously caused a reaction. It works by gradually introducing small doses of the drug until the body temporarily tolerates it. In this study, we reviewed the experiences of 11 adult patients who had allergic reactions to biologic agents such as rituximab, brentuximab vedotin, daratumumab, and pertuzumab. A total of 43 desensitization cycles were performed under close medical and nursing supervision in an intensive care unit. The desensitization plans were designed together by allergists and clinical pharmacists. The results showed that the procedure was safe and effective. Mild reactions occurred in a few cases, but no serious problems were seen. When premedication (such as steroids and antihistamines) was started more than 24 hours before the procedure, allergic symptoms were less frequent. This highlights the importance of careful planning and teamwork in making desensitization safer for patients. Keywords: biological agents, desensitization, drug hypersensitivity, monoclonal antibodies, rapid drug desensitization