A Montefiore Medical Center cardiac team has a patient on the table prepped for open-heart surgery when he breaks out in hives. It’s an allergic reaction to one of the medicines administered, and the surgery has to be aborted. Although allergies constitute as much as 10% of adverse reactions to medications, many patients’ lives depend on taking the very drugs to which they are allergic.
A solution to a case such as this is to administer a different medication from the one inducing the allergic reaction, although that drug has to be identified from the combination of drugs the patient has received. And because an alternative medication may be less beneficial, drug allergies can be a major obstacle to patient care.
Another alternative is drug desensitization therapy, a process that identifies the medication triggering the allergic response and steers the patient through a unique procedure to reduce or eliminate his or her reaction to the drug.
Elina Jerschow, M.D., M.S., FACAAI
Montefiore’s Desensitization Program, one of the few of its kind, is led by allergy and immunology specialist Elina Jerschow, M.D., M.S., FACAAI, Director of the Drug Desensitization Program, attending physician at Montefiore Medical Center and assistant professor of medicine (allergy and immunology), Albert Einstein College of Medicine.
The program’s specialists commonly see allergies to aspirin and penicillin, as well as adverse reactions to other antibiotics and chemotherapy drugs. At times, however, the allergen is unknown. That’s when a full evaluation — including skin prick, patch testing or IV testing — is performed to diagnose whether a patient is hypersensitive to a particular drug.
“There’s usually some detective work we have to do,” Dr. Jerschow says.
Once the drug is identified, the patient can undergo drug desensitization.
“The process involves a gradual introduction of small amounts of the medication the patient requires,” Dr. Jerschow says. “That’s how the patient develops a tolerance.”
In a closely monitored setting, a patient is administered a small, diluted dose of the medication to which he or she has demonstrated an allergic reaction. Over time, slowly escalating doses of the drug are dispensed with the goal that the body will no longer reject the drug.
Successful desensitization alters the immune response to the medication and allows the patient to safely receive the prescribed course of medication. The process can mean the difference between getting the best therapy the physician recommends or an alternative drug that may be less effective.
“It’s very rewarding when you can help someone in such a way that he or she can be treated with an appropriate medication,” Dr. Jerschow says.
In addition to her practice, Dr. Jerschow is conducting research seeking a new way to diagnose aspirin-sensitive asthma at Albert Einstein College of Medicine.
“We have some preliminary results that are promising,” she concludes. “We’re expecting to have something interesting to report.”
For more information about Montefiore Medical Center’s Drug Desensitization Program, visit www.montefiore.org/allergy-immunology.