Hypersensitivity reactions to chemotherapy: Outcomes and safety of rapid desensitization in 413 cases (original) (raw)
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Rapid Desensitization for Hypersensitivity Reactions to Chemotherapeutic Drugs; A Case Series
Iranian Journal of Pharmaceutical Research : IJPR, 2019
Usage of cancer chemotherapeutics drugs can be associated with adverse drug reactions. When IgE-mediated drug reactions are formed following administration of a chemotherapeutics drug that is a drug of choice, drug desensitization protocols can be helpful. HSR can be allergic or nonallergic, but the clinical manifestations are similar. RDD is effective when used appropriately, however it is often over utilized instead of performing a drug challenge. RDD is both an acceptable approach and a high-risk treatment modality in patients, in whom the offending agent is the first choice in chemotherapy. The safety of this modality has been acceptable in large studies. The side effects are often less frequent and less severe by repeating the protocol. We present 4 cases of successful desensitization in cancer patients, who have developed IgE- mediated reactions to their major chemotherapy drug.
Journal of Allergy and Clinical Immunology, 2009
Background: Rapid desensitization, a procedure for graded drug administration, allows for the safe readministration of a medication after certain types of hypersensitivity reactions (HSRs) and is indicated in cases in which there are no reasonable therapeutic alternatives. The use of rapid desensitization for HSRs to mAbs has not been validated. Objective: We sought to describe our experience with rapid desensitization to mAbs, including rituximab, infliximab, and trastuzumab. Methods: One hundred five rapid desensitizations were performed in 23 patients with a standardized 12-step, 6-hour protocol. Our approach to patient evaluation before desensitization is described. The severity, characteristics, and timing of both initial HSRs and HSRs during desensitization were determined by means of retrospective review of medical records. After a reaction during desensitization, patient-specific protocol modifications were made before each subsequent desensitization. Results: 104 of 105 desensitizations undertaken were successfully completed. We observed HSRs during 29% of desensitizations, including 27 mild reactions, 1 moderate reaction, and 2 severe reactions. Overall, reactions during desensitization were markedly less severe than initial HSRs, but reactions did recur in a minority of successive desensitizations. Conclusions: Rapid desensitization is a promising method for the delivery of monoclonal therapeutics after an HSR, but the possibility of a reaction remains with each desensitization.
BioDrugs, 2013
Hypersensitivity reactions to monoclonal antibodies and chemotherapy, which may vary in severity from mild to life-threatening, can lead to their discontinuation and replacement by alternative agents that are often less effective, more toxic, and/or more expensive. Drug desensitization has emerged as the best treatment modality capable of allowing re-introduction of the hypersensitivity reaction-inducing medication in highly sensitized patients in need of first line therapies. In recent years, the availability of new anti-neoplastic drugs and therapeutic monoclonal antibodies has increased, as has the potential for hypersensitivity reactions. Development of desensitization protocols for these new medications requires a careful assessment of the potential risks and benefits. The purposes of this review are to provide an overview of the presentation of hypersensitivity reactions amenable to desensitization and to increase awareness of the indications for and outcomes of desensitization protocols. Rapid drug desensitization has proven to be a safe and effective way of administering first line therapy to patients with hypersensitivity reactions, providing an extremely powerful treatment modality for patients for whom alternative drugs are deemed unacceptable. Rapid drug desensitization protocols should be administered only by highly trained allergists and nurses who have experience in determining which reactions are amenable to desensitization, and can identify high risk patients and provide them with appropriate care. Efforts should be made to increase awareness of the remarkable safety and efficacy of rapid drug desensitization among non-allergists, especially in the fields of oncology and rheumatology, so as to favor its universal application. Development of desensitization units to provide state-of-the-art care is possible only through coordinated teamwork.
Hypersensitivity to chemotherapeutics: a cross sectional study with 35 desensitisations
International journal of clinical oncology, 2014
Chemotherapy is one of the main treatments for lung cancer, and in these patients, discontinuation of treatment due to uncontrollable hypersensitivity reactions (HSRs) is an important problem. To determine the frequency of HSRs during chemotherapy and to review current approaches. We did a cross sectional study in patients undergoing chemotherapy for lung cancer in a reference chemotherapy unit from January 2012 to January 2013. Patients who developed immediate-HSRs or delayed-HSRs to chemotherapeutics and gave consent were included into study. The effectiveness of a standardised 12-step "rapid drug desensitisation" (RDD) procedure was investigated in patients with immediate-HSRs. In total, 1,099 cycles of chemotherapy were administered to 292 patients in 1 year. We observed ten HSRs, during ten cycles in ten patients (~3 % of the patients). Two HSRs were delayed-type, eight were immediate-type at grade 1-3. Of those with immediate-type HSR, five patients with grade 2-3, a...
Rapid Drug Desensitization with Biologics: A Single-Center Experience with Four Biologics
International Archives of Allergy and Immunology, 2016
most frequent presentation of HSR. Skin tests with rituximab were performed on 10 patients; only 3 resulted in positive IDTs (with 1: 100 dilutions) and the other tests were negative as were those performed with the other biologics. Of 96 RDDs, 89 desensitizations were performed with rituximab, 5 with cetuximab, 1 with infliximab, and 1 with trastuzumab. There were 12 (13.5%) breakthrough reactions, all of which were associated with rituximab and were less severe than the initial reactions. Conclusion: RDD was found to be safe and effective in the largest case series of RDDs with biologics in our country, Turkey.
A new rapid desensitization protocol for chemotherapy agents
Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología
Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar efficacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years. To assess the efficacy of a new desensitization protocol in patients allergic to chemotherapy drugs. We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used. We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carb...
Rapid Desensitization for Hypersensitivity Reactions to Medications
Immunology and Allergy Clinics of North America, 2009
The development of rapid desensitizations for the treatment of drug hypersensitivities is aimed at providing essential medications while protecting patients from IgE and non-IgE hypersensitivity reactions. Serious adverse drug reactions occur in 6.7% of hospitalized patients, and adverse drug reactions are the fourth to sixth leading cause of death in such patients. 1 Drug-induced type I hypersensitivity reactions, such as anaphylaxis, result from the release of mediators from IgE-sensitized mast cells and basophils. Drug-associated anaphylaxis can be triggered by b-lactam antibiotics, such as penicillin and cephalosporins, chemotherapy drugs, such as platins, therapeutic monoclonal antibodies, and others. 2-7 Cross-linking of IgE by drug antigens can lead to limited skin reactions (flushing, pruritus, urticaria, angioedema) or multiorgan system involvement (sneezing, sinus and nasal congestion, cough, shortness of breath, wheezing, abdominal pain, nausea, vomiting, diarrhea) with hypotension and cardiovascular collapse during anaphylaxis. Hypersensitivity reactions induced by drug antigens upon initial exposure, without prior sensitization and with symptoms similar to IgE-mediated reactions, are called ''non-IgE hypersensitivity reactions,'' and can result from direct release of mediators from mast cells and basophils, such in vancomycin-induced red man syndrome, intravenous contrast dyes, or taxenes. In these reactions, nontypical symptoms can occur, such as the severe back and muscle pain seen in patients with taxene and monoclonals reactions. 8
Gynecologic Oncology, 2005
Purpose of review Hypersensitivity reactions (HSRs) to chemotherapy agents have limited their use for fear of inducing severe reactions or death. Alternative regimens may be limited by tumor sensitivity and the need to provide first-line therapy. Rapid desensitizations allow patients to be treated with medications to which they have presented a HSR. The purpose of this review is to highlight the indications and recent developments in chemotherapy rapid desensitization protocols. Recent findings Intravenous and oral rapid desensitization protocols are available for taxenes, platinums, doxorubicin, monoclonal antibodies and others. Candidate patients present mild to severe type I hypersensitivity, mast cell/IgE-dependent reactions, as seen with platinums. Anaphylactoid reactions, such as those with taxenes, can be treated with the same protocols. Repeat desensitizations in outpatient settings are well tolerated and allow patients to remain in clinical studies/trials. Breakthrough symptoms during desensitizations are less severe than the initial reaction and no deaths have been reported. Cancer remissions are similar to those for nondesensitized patients. Summary The use of rapid desensitization protocols for cancer patients with HSRs to chemotherapy depends on their demonstrated tolerability and efficacy in selected populations. Education of nurses, pharmacists, and oncology and allergy specialists is needed to improve their universal application as standard of care.
Rapid Desensitization in Immediate Hypersensitivity Reaction to Drugs
Current Treatment Options in Allergy, 2015
Rapid drug desensitization I Drug hypersensitivity reaction I Adverse drug reaction I Anaphylaxis I Platinum compounds I Taxanes I Monoclonal antibodies I β-lactam antibiotics I Aspirin I Protocol Opinion Statement Adverse drug reactions have increased dramatically worldwide, often preventing the use of first-line therapies. Not infrequently, many patients presenting with drug hypersensitivity reactions are irreversibly labeled as allergic, fact that prevents them to receive the most appropriate treatment for their illnesses. Rapid drug desensitization has become a cornerstone in the management of immediate drug hypersensitivity reactions. It is the only effective procedure for overcoming hypersensitivity reactions to first-line therapy, thus representing an important advance in patients' treatment and prognosis. Continued reports on the safety and efficacy of rapid drug desensitization emerging from different institutions are essential to allow the dissemination of desensitization programs.