A practical 16-day desensitization protocol in lenalidomide-induced non-immediate hypersensitivity reactions

Ann Allergy Asthma Immunol. 2019 Oct;123(4):394-397. doi: 10.1016/j.anai.2019.07.031. Epub 2019 Aug 7.


Background: Desensitization in immediate-type hypersensitivity reactions (HRs) caused by chemotherapeutics is well described and standardized for many drugs. However, there are no standardized protocols in non-immediate HRs.

Objective: To evaluate the effectiveness of a 16-day desensitization protocol in the non-immediate HRs induced by lenalidomide.

Methods: According to our previously published slow desensitization protocol, we desensitized patients who had experienced non-immediate HRs attributable to lenalidomide. The protocol was started with the 1/100 of the daily-prescribed dose in milligrams of the culprit drug; then the doses were slowly increased to complete the procedure in 16 days. Demographic and clinical features of the patients were further appraised.

Results: Ten patients (mean age was 64.7 ± 10.8 years; 7 male) were successfully desensitized to lenalidomide. The mean reaction time was 7.3 ± 3.9 days in the history, and the reaction types were delayed urticaria (n = 4), eczematous rash (n = 3), and maculopapular eruptions (n = 3). The desensitization was successfully completed in 16 days in 9 patients. In 1 patient, maculopapular eruptions developed on the 11th day, and the patient was treated with corticosteroids. We repeated the previous tolerated dose longer and completed with a slower dose increasement, and the targeted dose was achieved in 35 days.

Conclusion: The 16-day desensitization protocol seemed to be safe and effective in the non-immediate type drug HRs caused by lenalidomide.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Desensitization, Immunologic / methods*
  • Drug Hypersensitivity / immunology
  • Drug Hypersensitivity / therapy*
  • Eczema / pathology
  • Exanthema / pathology
  • Female
  • Humans
  • Lenalidomide / adverse effects*
  • Lenalidomide / immunology*
  • Male
  • Middle Aged
  • Parapsoriasis / pathology
  • Urticaria / pathology


  • Adrenal Cortex Hormones
  • Lenalidomide