Requirements for implementation of antimicrobial desensitisation programs

Perform desensitisation in a hospital setting because patients require close monitoring. Resources (eg experienced staff, medications, equipment) for managing anaphylaxis and threatened airway must be available.

There is a high risk of adverse reactions during desensitisation. Desensitisation should be performed by trained clinicians and should be supervised by a clinician with expertise in drug allergy.Shenoy 2019

The role of premedication with an antihistamine or corticosteroid is unclear.

In higher-risk cases (eg a patient who has had an anaphylactic reaction during desensitisation to the same drug in the past), consider premedication (eg a single dose of prednisolone 0.25 to 0.5 mg/kg orally).

A process for monitoring during desensitisation is required. Patients require frequent monitoring during desensitisation (eg every 15 minutes).

Specialist advice is required for management of hypersensitivity reactions that occur during desensitisation.

For minor reactions (eg itch, urticaria, rash or rhinorrhoea), consider suspending desensitisation and discuss with the medical team. When symptoms have resolved, desensitisation may be restarted at 20 to 50% of the previously tolerated dose. Medications to manage these reactions (eg antihistamines) must be accessible.

For life-threatening reactions (eg anaphylaxis, bronchospasm, angioedema, hypotension), stop desensitisation and initiate a resuscitation protocol. Medications to manage anaphylaxis must be accessible.

Obtain informed consent from the patient before desensitisationAlvarez-Cuesta 2022.

Advise the patient that desensitisation is not a permanent cure for allergy. Ensure the patient understands that the effect of desensitisation is temporary, and that the allergy will return once therapy with the drug has stopped. Counsel the patient to avoid the drug in future. Desensitisation must be repeated if the drug is required again.