Hypersensitivity Reactions Associated with Platinum Antineoplastic Agents: A Systematic Review

Abstract

Platinum-containing chemotherapy agents (cisplatin, carboplatin, oxaliplatin) have been approved in the first-line setting of numerous malignancies, such as ovarian, bladder, head and neck, colorectal, and lung cancer. Their extensive use over the last decade has led to a significant increase in the incidence of hypersensitivity reactions, which are defined as unforeseen reactions whose signs and symptoms cannot be explained by the known toxicity of these drugs. Skin rash, flushing, abdominal cramping, itchy palms, and back pain are common symptoms. Cardiovascular and respiratory complications can prove fatal. Multiple pathogenetic mechanisms have been suggested. Hypersensitivity usually appears after multiple infusions, suggesting type I allergic reactions; however, other types of hypersensitivity also seem to be implicated. Several management options are available to treating physicians: discontinuation of chemotherapy, premedication, prolonging of infusion duration, desensitization protocols, and replacement with a different platinum compound after performing skin tests that rule out cross-reactions among platinum agents.

Hypersensitivity Reactions to Oxaliplatin: Clinical Features and Risk Factors in Koreans

“…In addition, there is not perfect tool to predict oxaliplatin-related hypersensitivity reactions. Skin testing for oxaliplatin showed 75% to 80% accuracy in previous two studies (Garufi et al, 2003;Morgan et al, 1994), but the usefulness of skin testing remains an issue of controversy (Makrilia et al, 2010).…”

Oxaliplatin-induced lung injury with allergic reaction

“…These reactions are in general caused by chemotherapeutic agents or their metabolites and are usually dose-dependent. Immunological reactions caused by the drug can be assumed to occur in 2 ways [3] . One is known to be anaphylactic reactions (type I hypersensitivity), which usually occur within minutes of administration in patients with prior exposure, including facial edema, bronchospasm, hypotension, tachycardia, pruritus, and erythema.…”

Factors Influencing the Appearance of Oxaliplatin-Induced Allergy

“…3,6) Urticaria, hot flushes, mucosal edema, or a reduction in the blood pressure occurs within a few minutes after exposure to a causative substance; therefore, type I is termed immediate allergy. This reaction is induced by immunoglobulin E (IgE) antibody.…”