The Use of Drug Desensitization Protocols at a Pediatric Institution
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Malika Gupta, MD, Jamie M Gomes, PharmD, BCPS, Jamie Sklar, RN, BSN, MS, CCRN-K, Sigrid Payne DaVeiga, MD
Rationale: Protocols for adults to achieve immunologic IgE and non-IgE induction of temporary drug tolerance (drug desensitization) have been well described.  Use of these protocols is recommended only when administration of the drug is essential and requires close collaboration between Allergists, nursing and pharmacy staff.  Application of these protocols to pediatric patients is further challenging due to variations in patient weights, target doses and minimum volumes required to infuse drugs.  We have established pediatric protocols based on adult guidelines at our pediatric tertiary care center to perform antibiotic desensitizations via a 12 step, 4 syringe method. We describe these protocols and their success.


Methods: We conducted a retrospective chart review of all patients who had drug desensitization performed between 1/1/2013 and 7/15/2015 under the supervision of a Pediatric Allergist using standardized desensitization protocols and reviewed their outcomes.


Results: In the given period, 5 patients underwent desensitization using the protocol involving 5 different antibiotics (ceftriaxone, ceftazidime, linezolid, ertapenem, oxacillin). Three of the 5 subjects were female and the mean age was 12 years (range of 3 -19 years). All 5 patients tolerated the desensitization procedure and subsequent dosing of the drug to complete the full therapeutic course.


Conclusions: Dose calculation for the various steps of drug desensitization is challenging in a pediatric population where there is a need for customized dosing. This procedure is cumbersome and prone to human error. The pediatric protocols established at our institution have been utilized with success and can potentially be applied to use for other agents