Two Cases of Severe Hypersensitivity Reactions After Paclitaxel Infusion

Abstract

Background. Hypersensitivity reaction after paclitaxel infusion may occur in spite of appropriate premedication. Case 1. Adenocarcinoma of the lung, stage IIIB, was diagnosed in a 75-year-old woman. We planned to treat her with carboplatin and weekly paclitaxel. On the first day of the first cycle of the chemotherapy she felt severe dyspnea and wheezing three minutes after starting paclitaxel administration. Soon after we halted paclitaxel infusion and treated her with methylprednisolone, her symptoms disappeared. Case 2. Stage IV adenocarcinoma of the lung was diagnosed in a 52-year-old man. We began treating him with carboplatin and weekly paclitaxel. On the first day of the second chemotherapy cycle, i.e. his second paclitaxel infusion, he complained of severe dyspnea 7 minutes after starting paclitaxel infusion. We treated him with methylprednisolone and epinephrine immediately, but he developed cardiopulmonary arrest after several minutes. His consciousness did not return in spite of successful cardiopulmonary resuscitation. We used appropriate premedication in each of these cases but hypersensitivity reaction occurred. In both cases marked eosinophilia was present before paclitaxel infusion. Conclusion. Premedication, consisting of histamine antagonists and steroids, is widely used, but does not completely interrupt the paclitaxel-related hypersensitivity reaction. We should recognize the possibility of such severe hypersensitivity reaction cases.