A protocol for risk stratification of patients with carboplatin-induced hypersensitivity reactions

• Published in: Journal of allergy and clinical immunology Vol. 129; no. 2; pp. 443 - 447
• Main Authors: Patil, Sarita U., MD, Long, Aidan A., MD, Ling, Morris, MD, Wilson, Michael T., MD, PhD, Hesterberg, Paul, MD, Wong, Johnson T., MD, Banerji, Aleena, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2012; Elsevier; Elsevier Limited
• Subjects: Allergies; Allergy and Immunology; Biological and medical sciences; Carboplatin; Carboplatin - adverse effects; Carboplatin - immunology; desensitization; Desensitization, Immunologic; drug allergy; Drug dosages; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Drug Hypersensitivity - therapy; False Negative Reactions; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; hypersensitivity; Immunology; Immunopathology; Male; Medical sciences; Middle Aged; Patient safety; Patients; Risk; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; skin testing; Skin Tests; ST; hypersensitivity; drug allergy; HSR; Carboplatin; skin testing; desensitization; Hypersensitivity reaction; Skin test; Antineoplastic agent; Human; Drug; Allergy; Immunopathology; Desensitization; Hypersensitivity; Exploration; Risk; Immunology; Risk factor; Platinum II Complexes
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2011.10.010

Background Management of patients with carboplatin-induced hypersensitivity reactions (HSR) has been complicated by high false-negative rates of carboplatin skin test (ST) results. These patients might be at risk for future carboplatin-induced HSRs. In this article we identify a strategy to improve risk stratification of patients with a history of carboplatin-induced HSRs by using a protocol that includes repeat skin testing and drug desensitization. Objective We sought to identify a management strategy for patients with a history of carboplatin-induced HSRs with negative carboplatin ST results. Methods From 2008-2010, patients with carboplatin-induced HSR underwent risk stratification per a protocol using 3 repeat STs with intervening drug desensitizations. Results Of the 44 patients with carboplatin-induced HSRs, 39 completed the protocol. Patients were classified as having positive ST results (n = 16), having negative ST results (n = 11), or ST converters when the ST result converted to positive after an initial negative result (n = 12). ST converters are more likely to have HSRs during subsequent desensitizations than patients with negative ST results (56.1% vs 4.5%, P  < .001). ST converters had a significantly longer time interval between their initial HSR and initial ST evaluation compared with either patients with true-negative ST results (22.1 vs 6.0 months, P  = .03) or patients with positive ST results (22.1 vs 1.8 months, P  = .001). Conclusion Our experience suggests that repeat STs are necessary for risk stratification in patients with a remote clinical history of HSR and an initial negative ST result because there is a significant rate of conversion to a positive ST result. ST converters have an increased risk of HSRs during subsequent carboplatin treatment.