Hypersensitivity and desensitization to antineoplastic agents: outcomes of 189 procedures with a new short protocol and novel diagnostic tools assessment

• Published in: Allergy (Copenhagen) Vol. 68; no. 7; pp. 853 - 861
• Main Authors: Madrigal‐Burgaleta, R., Berges‐Gimeno, M. P., Angel‐Pereira, D., Ferreiro‐Monteagudo, R., Guillen‐Ponce, C., Pueyo, C., Gomez de Salazar, E., Alvarez‐Cuesta, E.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.07.2013
• Subjects: Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - immunology; Antineoplastic Agents - therapeutic use; chemotherapy; Clinical outcomes; Cohort Studies; desensitization; Desensitization, Immunologic - methods; Diagnostics; Dose-Response Relationship, Drug; drug allergy; Drug Hypersensitivity - immunology; Drug Hypersensitivity - prevention & control; Female; Humans; ImmunoCAP; Immunoglobulin E - immunology; Infusions, Intravenous; Male; Middle Aged; Organoplatinum Compounds - adverse effects; Organoplatinum Compounds - immunology; Organoplatinum Compounds - therapeutic use; oxaliplatin; Prospective Studies; Pyridines - adverse effects; Pyridines - immunology; Pyridines - therapeutic use; Sensitivity analysis; Sensitivity and Specificity; Skin Tests - methods; Treatment Outcome; oxaliplatin; drug allergy; chemotherapy; ImmunoCAP; desensitization
• ISSN: 0105-4538; 1398-9995
• DOI: 10.1111/all.12105

Background Desensitization to antineoplastic agents is becoming a standard of care. Efforts to establish and improve these techniques are being made at many institutions. Our aims are to evaluate a new rapid desensitization protocol designed to be shorter (approximately 4 h) and safer (reducing hazardous drugs exposure risks) and to assess the oxaliplatin‐specific immunoglobulin E (IgE) as a novel diagnostic tool. Methods Prospective, observational, longitudinal study with patients who, for a 1‐year period, suffered reactions to antineoplastic agents and were referred to the Desensitization Program at Ramon y Cajal University Hospital (RCUH). Patients were included or excluded as desensitization candidates after anamnesis, skin testing, risk assessment, and graded challenge. Specific IgE was determined in oxaliplatin‐reactive patients. Candidate patients were desensitized using the new RCUH rapid desensitization protocol. Results Of 189 intravenous rapid desensitizations, 188 were successfully accomplished in the 23 patients who met inclusion criteria for desensitization (of 58 referred patients). No breakthrough reactions occurred in 94% of desensitizations, and most breakthrough reactions were mild. In 10 oxaliplatin‐reactive patients, 38 desensitizations were successfully accomplished. Sensitivity for oxaliplatin‐specific IgE was 38% (0.35UI/l cutoff point) and 54% (0.10UI/l cutoff point); specificity was 100% for both cutoff points. Conclusions In the hands of a Desensitization Program, managed by drug desensitization experts, this new protocol has proven an effective therapeutic tool for hypersensitivity to several antineoplastic agents (oxaliplatin, carboplatin, paclitaxel, docetaxel, cyclophosphamide, and rituximab); moreover, it improves safety handling of hazardous drugs. We report the first large series of oxaliplatin desensitizations. Oxaliplatin‐specific IgE determination could be helpful.