Division of Allergy & Immunology

New Chemotherapy and Biologic Agent Desensitization Program

Helping Patients Better Tolerate Chemotherapy Drugs 

Amy Sacks

chemo bag

What happens when a cancer patient is allergic to the very drug that can fight their disease? 

It’s a valid fear among the minority of cancer patients who find themselves allergic to their intravenous chemotherapy drug.  Reactions from chemo infusions can vary from mild hives, flushing and wheezing, to more severe reactions as anaphylactic shock, heart attack, or even death. In the past, physicians had to stop the infusion, leaving the patient with a suboptimal drug alternative -- and a fading hope for survival.

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Elina Jerschow, MD

“If a person has so few drug options, and an allergy on top of that, in the old days we had nothing else to offer them,” said Elina Jerschow, MD, Director of the Montefiore Drug Allergy Center and Associate Professor of Clinical Medicine (Allergy & Immunology) at Albert Einstein College of Medicine.  

Previously, patients who suffered allergic reactions during chemo or biologic infusions were sent to the ICU because the clinic lacked the trained nursing staff and capacity to administer infusions.   But that required an overnight stay, and ICU beds are not easy to come by.

Now, Montefiore’s new Chemotherapy and Biologic Agent Desensitization Program (CBDP) will help patients better tolerate their cancer drugs.  Set to formally launch in fall 2017, it is among a handful of programs in the United States that provide chemotherapy and biologic allergy desensitization in an outpatient setting. 

Collaborating with the Oncology Infusion Team

The CBDP will be led by Melissa Iammatteo, MD, a current PGY-5 Allergy/Immunology fellow who will be joining the Albert Einstein College of Medicine faculty as an Assistant Professor of Clinical Medicine (Allergy and Immunology).  Dr. Iammatteo has been instrumental in developing the program in collaboration with Dr. Jerschow.  The CBDP will be a joint venture between the Division of Allergy and Immunology’s Drug Allergy and Desensitization Center and the Montefiore Einstein Center for Cancer Care Oncology Infusion Center. 

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Melissa Iammatteo, MD

Dr. Iammatteo will perform skin testing and IV desensitization in collaboration with oncology nurses at the Oncology Infusion Center.  The oncology team also includes Stuart Packer, MD, the Clinical Director of the Medical Oncology Service, Weiler campus; oncology pharmacists Roy Brown and James (Jim) McCarthy; and Barbara Binder, RN, Administrative Director, Oncology Services.

“Our program will enable many patients with hypersensitivity reactions to chemotherapeutic agents and biologic agents to receive first-line therapeutic regimens for potentially life-threatening illnesses in a safe, controlled environment," Dr. Iammatteo said.

Decreasing Sensitivity to the Allergen

Desensitization is the process of decreasing a patient's sensitivity to an allergen over time.  The physician administers an intravenous medication, starting the infusion in very small doses and slowly increasing the dose every 15 to 20 minutes. In most cases, the patient can safely receive the prescribed dosage of the medication they need within 5 to 7 hours, without suffering an allergic reaction. There are generally workarounds for injectable and oral drugs.

The chemo desensitization treatment was pioneered at Harvard Medical School by Marianna Castells, MD, PhD, who established the “rapid desensitization” unit at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).

"The CBDP will be a much-needed expansion of the Montefiore Drug Allergy Program," said Allergy and Immunology division chief, David Rosenstreich, MD, Professor in the Departments of Medicine (Allergy & Immunology), Microbiology & Immunology and Otorhinolarygology – Head and Neck Surgery.

Drs. Iammatteo and Jerschow are currently conducting a prospective study to assess the safety and outcomes of performing placebo-controlled graded drug challenges without prior skin testing in patients with a low-risk history of hypersensitivity reaction to antibiotics. They are also researching the etiology of perioperative hypersensitivity reactions in patients who presented to the drug allergy clinic between 2009 and 2017.

They recently published a paper, “Identifying Allergic Drug Reactions Through Placebo-Controlled GradedChallenges,” in the Journal of Clinical Allergy and Immunology: In Practice.

The Drug Allergy Desensitization Center 

The Montefiore's Drug Allergy/Desensitization Center provides care to patients with allergies, asthma and immune deficiencies.  It was established in 2009 by Dr. Elina Jerschow, Center and Associate Professor of Clinical Medicine (Allergy & Immunology) at Albert Einstein College of Medicine. This Center currently serves not only Bronx community but also the entire Tri-State Area (The Greater New York area, New Jersey, and Connecticut) and has become an official referral site for drug allergy evaluations in patients with STDs from New York City Department of Health.

The popularity of this Center is evidenced by a greater than 50-fold increase in the number of drug allergy evaluations since the establishment of the Program.

After completing her allergy/immunology fellowship at Montefiore, Dr. Jerschow joined Merck & Co., Inc. as an associate director in the Department of Clinical Immunology. Her research focused on evaluating adverse drug reactions in study participants, and on developing new therapeutic immunology targets.  Dr. Jerschow returned to the Einstein/Montefiore Department of Medicine in 2009 to establish the center.  She has also developed an active research program to study the pathogenesis of drug allergies and hypersensitivities, with a particular emphasis on improving diagnostic and therapeutic approaches to drug-related allergic conditions.

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