Incidence, clinical features and management of hypersensitivity reactions to chemotherapeutic drugs in children with cancer

Abstract

With the increasing use of cancer chemotherapy agents, hypersensitivity reactions to antineoplastic drugs are commonly encountered. Clinicians must not underestimate the potential risk and occurrence of HSRs in the pediatric population. Knowledge of the different presentations of these reactions can help to develop strategies for the prevention and the management of HSRs in order to ensure treatment outcome, to improve the quality of patient care and to reduce healthcare costs.

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

“…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 .…”

“…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. 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.…”

Rechallenge to Carboplatin in Children with Low Grade Glioma and Carboplatin Hypersensitivity Reactions

“…Moreover, the prolonged use of steroids is associated with long term side effects in children and adolescents, such as mood changes, weight gain and osteoporosis (Ruggiero et al, 2013a). The success of re-exposure in the studies that have used only premedication was between 0 and 28% (Genc et al, 2012).…”

“…This difference could be due to the different patterns of desensitization used. The main variables influencing the success of re-exposure appear to be: the starting dose, the infusion rate and the number of increments (Lafay-Cousin et al, 2005; Ruggiero et al, 2013a; Dodgshun et al, 2016; Shah et al, 2016). A lower starting dose, a slow infusion, and a number of increments greater than or equal to 4, are associated with a greater probability of success.…”

Commentary: A systemic digestive allergic reaction imputable to docetaxel in a breast cancer patient

“…Most reported cases of chemotherapy-induced HSRs are either immediate and IgE-mediated (type I), or delayed and T-cell mediated (type IV), according to the Gell and Coombs classification [3][4][5][6][7][8][9] . In our daily oncological practice, these HSRs mainly involve platinum and taxane, and clinical manifestations range in severity from pruritus to anaphylactic shock.…”