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Platin-based chemotherapeutic agents are associated with hypersensitivity reactions (HSRs), occurring in 12% of patients with gynecologic malignancy receiving carboplatin. 1 HSRs occur in 5-16% of patients with gynecologic malignancy receiving cisplatin, and up to 25% in patients with multiple cancer types (including gynecologic) receiving oxaliplatin. 2-3 Platin HSRs may lead to use of alternative therapies with potentially worse outcomes particularly for platin responsive-tumors. 4 Although skin testing (ST), desensitization and risk stratification protocols for platin HSRs allow patients to safely receive platins, they are not widely used. 5 To better understand the safety of platin ST, we conducted a literature review from January 2000 to June 2018 (Table 1) using the following search terms in PubMed: carboplatin ST (69 results), cisplatin ST (95 results), oxaliplatin ST (44 results), and platinum ST (166 results). Other search terms (e.g., carboplatin testing, cisplatin testing, oxaliplatin testing, platin ST) did not yield additional articles. We found 44 studies describing 1,393 patients who received platin ST. Two (0.1%) systemic reactions occurred immediately after ST. One patient with positive carboplatin intradermal testing (concentration not reported) developed symptoms 30 minutes later: diffuse erythroderma and subjective chills, dyspnea, and chest discomfort. 6

Anti-TNF agents and immune checkpoint inhibitors have significant, immune-mediated cutaneous manifestations that can necessitate discontinuation. Anti-TNF agents, IL-6 inhibitors, and IL-12/23 inhibitors can paradoxically cause psoriasis flares or unmask previously undiagnosed psoriasis. IL-17 inhibitors are unique in increasing risk for Candida infections. Benign injection site reactions, non-specific rash, cellulitis, and hypersensitivity reactions are relatively common adverse events. A wide variety of cutaneous reactions caused by biologics have been reported, ranging from benign injection site reactions to life-threatening cutaneous reactions necessitating discontinuation of the implicated biologic agent.