Hypersensitivity reactions to chemotherapy: Outcomes and safety of rapid desensitization in 413 cases

Castells, Mariana; Tennant, Nichole M.; Sloane, David E. E.; Hsu, Florence Ida; Barrett, Nora A.; Hong, Deli; Laidlaw, Tanya M.; Legere, Henry J.; Nallamshetty, Samridhi N.; Palis, Ross I.; Rao, Jayanti; Berlin, Suzanne; Campos, Susana M.; Matulonis, Ursula A.

doi:10.1016/j.jaci.2008.02.044

Cited by 477 publications

(596 citation statements)

References 26 publications

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“…The dose is increased by half-log or doubling increments at 15-min intervals for IV desensitization or at 45-60 min for oral desensitization until the therapeutic dose is achieved [207] (Appendix , Table A3). Standard protocols for IV desensitization have been published and can be adapted for a range of drugs [218][219][220]. These protocols are • Resensitization occurs in a minority of cases.…”

Section: Desensitizationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Desensitizationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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“…Patients receiving multiple doses of chemotherapy can become sensitized to the drugs, and subsequent exposure to these agents can lead to hypersensitivity reactions (HSRs) and death. 3 A wide spectrum of drugs can sometimes give rise to numerous adverse oral manifestations, particularly dry mouth, taste disturbances, swelling, and/or oral mucosal ulceration.6 Hypersensitivity reactions (HSRs) may occur in patients treated with chemotherapeutic drugs (especially platinum compounds, methotrexate, Lasparaginase), with mild/moderate to severe clinical patterns 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, subsequent exposure to these agents can lead to hypersensitivity reactions (HSRs) and death. 3 HSRs may occur in children with cancer, treated with chemotherapeutic drugs (especially platinum compounds, methotrexate, Lasparaginase), with mild/moderate to severe clinical patterns. 4 It often requires that the provoking medication be discontinued.…”

Section: Introductionmentioning

confidence: 99%

“…But this is also raising a dilemma for the caregiver, since further use could precipitate a severe, even fatal, allergic reaction on re-exposure, but alternative drugs might be poorly tolerated or much less effective compared with the preferred agent. 3 Complications resulting from cancer, or secondary to cancer treatment, frequently occur in the oral cavity and are often nonspecific. The reported incidence of such complications in the literature varies considerably, but they appear to be far more common in children 5 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oral Involvements of Hypersensitivity Reactions to ChemotherapyDrugs in Immunocompromised Child Patient: A Case Report

Erwana

Sufiawati

2017

UIP HEATH MED

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“…Such procedures have been carried out for decades with patients allergic to penicillin 3 . In recent years numerous publications have referred to procedures of desensitization to chemotherapy drugs carried out with success, safety, and efficacy in numerous patients 4,5,6 . We found only one study of desensitization to HCQ 7 , involving 4 patients who developed a rash coinciding with administration of the drug, and who then tolerated the procedure.…”

Section: To the Editormentioning

confidence: 99%