Does Rapid Drug Desensitization to Chemotherapy Affect Survival Outcomes?

Berges-Gimeno, M P; Carpio-Escalona, L V; Longo-Muñoz, Federico; Bernal-Rubio, Lorena; López-González, Paula; Gehlhaar, P; Pachón, Vanessa; Ferreiro-Monteagudo, Reyes; Madrigal-Burgaleta, Ricardo; Álvarez-Cuesta, Emilio

doi:10.18176/jiaci.0425

Cited by 26 publications

(25 citation statements)

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“…Desensitization is a safe and highly effective procedure, not only for IgE-mediated reactions but also for those mediated by non-IgE mechanisms [3,5]. The benefits of the procedure include an improvement in the overall survival of treated patients compared to using no-first line treatments [5][6][7], as well as a reduction in costs [5]. The likelihood of breakthrough reactions (BTR) during desensitization is low and, moderate to severe reactions are infrequent [8].…”

Section: Introductionmentioning

confidence: 99%

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

Vega¹,

Jiménez-Rodriguez²,

Barranco³

et al. 2021

J Investig Allergol Clin Immunol

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Section: Introductionmentioning

confidence: 99%

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

Vega¹,

Jiménez-Rodriguez²,

Barranco³

et al. 2021

J Investig Allergol Clin Immunol

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“…Patients received a median of 11 uneventful oxaliplatin sessions before the initial HSR. 19 In our study, HSRs to oxaliplatin occurred in the median third cycle. The rate of HSRs to platinum compounds usually increases after six doses, but it can be also seen before the sixth dose with a rate of 1%.…”

Section: Discussionmentioning

confidence: 52%

Rapid drug desensitization with platin-based chemotherapy: Analysis of risk factors for breakthrough reactions

Akin

Erkoç

Öztürk

et al. 2022

World Allergy Organization Journal

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Background All platin-based chemotherapeutics can cause hypersensitivity reactions (HSRs). With rapid drug desensitization (RDD), few patients experience breakthrough reactions (BTR) during desensitization. However, data about risk factors for BTRs during RDD in patients with HSRs to platins are limited. We first aimed to describe characteristics of our platin-reactive population and to validate the Brigham and Women's Hospital's (BWH's) RDD protocol in our population along with their outcomes with RDD. Our second aim was to identify the risk factors for BTRs. Method This was a retrospective chart review (2013–2020) of patients with symptoms of immediate HSRs to platins. Initial HSRs were classified as grade 1, 2, or 3 based on their severity. Skin prick tests (SPT)/intradermal tests (IDT) were performed with implicated platins. A 12-step protocol was used during RDD. Results The study comprised 65 women and seven men (mean age 57.78 ± 8.73 years). Initial HSRs to carboplatin, cisplatin, and oxaliplatin occurred in 38, 13, and 21 patients, respectively. All patients reacted at the fifth (median) recurrent infusions (min:1, max:20). The median values for carboplatin, cisplatin, and oxaliplatin were 6 (1–20), 3 (1–15), and 3 (1–11), respectively. Most initial HSRs were grade 2 (n = 40, 55.6%) and 3 (n = 27, 37.5%); only 6.9% (n = 5) were grade 1. Patients with grade 1, 2, and 3 initial HSRs had positive platin skin test results at rates of 80%, 74%, and 88%, respectively. A total of 232 RDDs were performed in 72 patients and 98.7% of these desensitizations were completed. BTRs occurred in 56 (24.1%) (grade 1 n = 14, 25%; grade 2 n = 32, 57%; grade 3 n = 10, 18%) of these desensitizations. Breakthrough reactions were more severe in patients with positive SPTs or 1:100 or 1:10 dilutions of IDT (p = 0.014). BTR was not observed during RDD in any of the patients with positive 1:1 dilutions of IDT. Positivity on prick or 1:100 or 1:10 IDT increased the risk of BTR 5.058 times. There was no significant association between the risk of BTRs and age, drug cycle, sex, comorbidities, or atopy. Conclusion In our experience, 98.7% of 232 RDDs to platins were completed successfully, showing that RDD was safe and effective. Drug skin test positivity is a potential marker for identifying high-risk patients who will have BTRs during RDDs to platins.

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“…RDD is the backbone of the therapeutic approach to drug allergy, as it is the only technique available for patients to safely receive a drug to which they have become allergic 9,10 . RDD allows chemotherapy‐allergic patients to have similar survival outcomes to their non‐allergic counterparts and it is cost‐effective 5,15 …”

Section: Figurementioning

confidence: 99%

Medical algorithm: Diagnosis and treatment of hypersensitivity reactions to cancer chemotherapy

Madrigal-Burgaleta

Vazquez-Revuelta

Martí-Garrido

et al. 2021

Allergy

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Medical algorithm: Diagnosis and treatment of hypersensitivity reactions to cancer chemotherapyAll antineoplastic drugs could potentially trigger a drug hypersensitivity reaction (DHR); however, as described in different populations, DHRs are especially frequent with platinum drugs, taxanes and biologics. [1][2][3][4][5][6][7] Other drugs that can usually trigger DHRs, with varying incidence depending on the population, are namely, anthracyclines, irinotecan, cyclophosphamide, gemcitabine or even concomitant agents such as leucovorin. 1,5,6 The diagnosis and treatment

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Does Rapid Drug Desensitization to Chemotherapy Affect Survival Outcomes?

Cited by 26 publications

References 0 publications

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

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

Rapid drug desensitization with platin-based chemotherapy: Analysis of risk factors for breakthrough reactions

Medical algorithm: Diagnosis and treatment of hypersensitivity reactions to cancer chemotherapy

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