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Drug Allergy and Desensitization Program

The Massachusetts General Hospital Drug Allergy and Desensitization Program evaluates drug allergies (adverse drug reactions) and conducts drug challenges and drug desensitizations to help patients tolerate many different drugs, including chemotherapy, antibiotics, aspirin and anesthetic agents.

Our Goal: The Most Effective Treatment

At the Mass General Drug Allergy and Desensitization Program,  our goal is to enable our patients to take a full dose of their recommended medication safely (if truly necessary) despite a previous allergic reaction. For many of our patients, this had been impossible before treatment and evaluation at Mass General.

Providing expert evaluation of many different classes of drugs, we aim to ensure patients can receive a full dose of the safest and most effective medication to treat their condition. We most commonly evaluate patients who have possible adverse reactions to:

  • Chemotherapy: for various forms of cancer
  • Antibiotics: for various infectious diseases
  • Aspirin: for heart disease
  • Anesthetic agents, including both general and local anesthetics

Drug allergies can be difficult to evaluate accurately because the patient may be taking multiple medications or may have had an allergic reaction long ago. Diagnostic testing that frequently is accurate, such as skin testing, is not available for drugs. Our allergists' leadership and experience in clinical care and research, practice of staying abreast of the current literature and ability to offer drug challenges and desensitizations are key reasons why Mass General excels in managing drug allergies.

What to Expect

At your initial evaluation, your physician will discuss your medical history and any previous allergic reactions, and conduct a thorough physical examination. We then will schedule skin and/or blood tests if appropriate.

If your history and evaluation confirms a drug allergy, we first consider whether you can take an alternative drug to treat your condition. If not, we may recommend a drug challenge or drug desensitization.

Drug Challenge: We will perform a graded drug challenge under close monitoring and supervision if your evaluation suggests you are unlikely to experience an allergic reaction to the medication. During the challenge, we will give you two to four doses of the medication in increasing amounts—carefully monitoring you for adverse reactions along the way—to ensure you can tolerate the full intended treatment dose.

Drug Desensitization: We will perform a drug desensitization if your evaluation suggests you are at significant risk for suffering an allergic reaction to the medication. Desensitization involves taking escalating doses of the medication at a very slow rate of progression until reaching the optimal dose. Safety is always our first priority. Because drug desensitization carries certain risks, we always complete the procedure in a Mass General inpatient unit. Our entire team's experience with drug desensitizations helps us to anticipate possible complications and address them quickly and successfully.

Where appropriate, we work with other world-class specialists at Mass General (e.g. oncologists, infectious disease specialists, cardiologists) to develop your treatment plan.

Diagnosing & Treating Drug Allergy

The Mass General Drug Allergy and Desensitization Program offers a full range of diagnostic and therapeutic services at our main campus in downtown Boston. Allergists at Mass General West in Waltham are available for initial consultations as well.

We provide expert evaluation of many different classes of drugs. This is one of the only programs in the Northeast to test for allergies to drug types such as:

  • Chemotherapy agents
  • Steroids
  • Monoclonal antibodies
  • Local anesthetics
  • General anesthetics
  • Antibiotics

Depending on the patient's clinical history and whether an acceptable alternative drug exists, we may follow up initial skin and/or blood testing (when appropriate) with a drug challenge or drug desensitization.

Leadership in the Field

Aleena Banerji, MD, one of the founders of the Drug Allergy and Desensitization Program, is known nationally for her expertise in this area. Through her research and clinical efforts, she has improved methods of evaluating drugs so we can administer a full dose of the most effective therapy for the patient's condition.

Her current research includes studying the role of basophils (a type of white blood cell) in drug allergy with colleague Wayne Shreffler, MD, PhD. Drs. Banerji and Shreffler are trying to determine if evaluating basophils will allow them to better diagnose allergies to selected drugs.

Educating the Next Generation

We are dedicated to preparing the next generation of academic clinicians and basic scientists in allergy and immunology. Fellows in the Allergy and Immunology Training Program receive clinical and research training in drug allergy and all other major conditions. Internal medicine residents also gain exposure to drug-allergy patients as part of their general training.

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