Rapid desensitization to antineoplastic drugs in an outpatient immunoallergology clinic

Hypersensitivity Reactions to Cancer Chemotherapy: Practical Recommendations of ARADyAL for Diagnosis and Desensitization

“…Finally, Caiado et al [88]found that total IgE>100 kU/L and >10 previous cycles were risk factors (OR 8.24 and 4.11, respectively) for BTR, particularly for platinum compounds. However, atopy, ST results or severity of the initial DHR were not included in the multivariate analysis.…”

“…Total IgE has been suggested as a good predictor of a positive hypersensitivity diagnosis for platins [88], although further research is required. DHR diagnosis to platinum compounds has been studied in large samples of patients, allowing to establish the specific IgE (sIgE) diagnostic yield to these agents, showing high specificity (75-100%), but low sensitivity (34-75%) [22,23,73,89,90].…”

“…A common finding in the RDD to ChD and mAb series is the high success rate and both the low number and severity of BTR [5,14,21,70,88,121,138]. However, despite being generally mild, there is still up to 25% of reactions [5,14,21,70,88,121,138]. Different risk factors have been described that partially differ from one series to another, as discussed below.…”

“…Most publications based on the BWH protocol [5], show the routinely use of H1blockers (H1b) and H2-blockers (H2b) in all patients [3,5,14,88,139]. Additional premedication could be administered based on the symptoms that the patient experienced during the initial reaction [140] such benzodiazepines for anxiety [21,88], paracetamol, opioids and other NSAIDs for fever, pain, rigor and chills. Indeed, aspirin and montelukast 10 mg 2 days prior to the desensitization is respectively added in those patients with flushing and respiratory symptoms [5,21,88,140].…”

“…Additional premedication could be administered based on the symptoms that the patient experienced during the initial reaction [140] such benzodiazepines for anxiety [21,88], paracetamol, opioids and other NSAIDs for fever, pain, rigor and chills. Indeed, aspirin and montelukast 10 mg 2 days prior to the desensitization is respectively added in those patients with flushing and respiratory symptoms [5,21,88,140]. Breslow et al [141] demonstrated that those additional drugs, added to the H1b/H2b, successfully reduced the severity of the reactions occurring during desensitization more effectively than a group receiving methylprednisolone (0.5 vs 1.75).…”