Rituximab hypersensitivity reactions are rare but are one of the main causes of rituximab elimination from antilymphoma\nimmunochemotherapy treatments. While the clinical picture may be indistinguishable from other infusion-related reactions,\nhypersensitivity reactions (HSR) do not disappear and instead become more intense with subsequent administrations. Objective.\nTo describe the use of the 12-step protocol for desensitization to intravenous rituximab in clinical practice and the complementary\nstudy of a possible IgE-mediated HSR in the context of B-cell lymphoma treatment. Methods. A 12-step rituximab desensitization\nprotocol was performed prospectively within clinical practice in 10 patients with a history of severe infusion reactions or in\npatients who had a repeated reaction at subsequent doses despite taking more intense preventive measures. Skin prick tests were\nperformed at the time of reaction and at a later time to eliminate false negatives due to possible drug interference. Results. Overall,\nwith the desensitization protocol, 70% of patients were able to complete the scheduled immunochemotherapy. Two patients had to\ndiscontinue the therapy due to clinical persistence and the third due to lymphoma progression. Intradermal tests with 0.1%\nrituximab were positive in only 20% of cases, demonstrating a mechanism of hypersensitivity. Conclusions. The 12-step desensitization\nprotocol is very effective and assumable within healthcare practice. There is a need to determine the mechanism\nunderlying the infusion reaction in a large proportion of cases due to the risk of future drug exposure.
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