Rapid drug desensitization (RDD) for patients experiencing hypersensitivity reactions (HSRs) to chemotherapeutics and biological therapeutic agents allows for temporary tolerance to the implicated drug, since this procedure requires intensive labor and time, alternative single-bag RDD protocols have been developed. We aimed to share our experiences with single-bag and multi-bag RDD in patients with HSRs to chemotherapeutics and biological agents.

Patients who were administered a single or three-bag RDD with implicated chemotherapeutics and biological agents between January 2020–August 2024 were included. The severity of HSRs was classified according to the Brown classification. Prick and intradermal tests were performed with the implicated drugs.

A total of 153 patients (F:121, M:32, Mean age:56.7 ± 11.4) were included, 109 of whom had experienced HSRs to platinum, 37 to taxanes, and 7 to biological agents. The initial severity was mostly grade 2 (n:84,54.9%) or grade 3 (n:50,32.7%). Skin testings were positive in 70 of 139 patients tested. A total of 582 RDD procedures were performed to 76 patients with the single bag-12-step protocol and to 77 patients with the three-bag-12-step protocol. No statistically significant differences were found between the single-bag and three-bag groups regarding age, sex, atopy, presence of comorbidities, initial reaction severity, and skin test positivity. During the 582 RDD procedures, 44 breakthrough reactions (22 in each group) occurred. Ultimately, 581 out of 582 RDD procedures (99.8%) were successfully completed, except one patient with grade 2 reaction in the single-bag group. The desensitization procedures were completed in 273 ± 42 min for the single-bag group and in 367 ± 33 min for the three-bag group (p-value <0.001).

Our study demonstrated that the single-bag protocol is as safe and effective as the three-bag protocol, while also providing a time-saving advantage. Thus, it is considered a viable alternative to multi-bag desensitization protocols.

Chemotherapy

Desensitization

Drug hypersensitivity

Neoplasms

Biologics

© 2025 The Authors. Published by Elsevier Inc. on behalf of World Allergy Organization.