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Villarreal-González RV, González-Díaz S, Vidal-Gutiérrez O, Cruz-de la Cruz CDL, Pérez-Ibave DC, Garza-Rodríguez ML. Hypersensitivity reactions to anticancer chemotherapy and monoclonal antibodies: Safety and efficacy of desensitization. J Oncol Pharm Pract 2024; 30:811-822. [PMID: 37489025 DOI: 10.1177/10781552231189461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Hypersensitivity reactions to anticancer chemotherapy and monoclonal antibodies may lead to discontinuation of first-line treatment options. Identification of these reactions can provide specific diagnosis and treatment by rapid drug desensitizations. OBJECTIVE To determine the hypersensitivity reactions involved in anticancer chemotherapy and monoclonal antibodies, and the safety and efficacy of rapid drug desensitization. METHODS We conducted an observational study of hypersensitivity reaction presented after the administration of anticancer chemotherapy and monoclonal antibodies in Mexico. We documented the symptoms of initial reaction and their severity, and the results of skin tests. We also report our experience of the administration of 12-step (mild-moderate reactions) and 16-step (severe reactions) desensitization protocols in these patients. RESULTS Overall, 93 patients received 336 rapid drug desensitization; 105 to taxanes, 115 to platinum drugs, 101 to monoclonal antibodies, and 15 other anticancer chemotherapy. Hypersensitivity reaction to taxanes occurred in the first or second administration, platinum drugs after the sixth cycle, and rituximab in the first cycle. The most common symptom in carboplatin was urticaria, paclitaxel back pain, oxaliplatin and docetaxel dyspnea, and in the monoclonal antibodies cardiovascular symptoms. Skin tests were positive in 75% of the carboplatin group, and only 16.7% in docetaxel. There was a rapid drug desensitization success rate of 99.4% and 85.7% did not present any related hypersensitivity reaction. CONCLUSION The diagnosis of hypersensitivity reaction to anticancer chemotherapy and monoclonal antibodies offers a panorama in the management of oncological diseases. Our standardized desensitization protocol is safe and effective and can be reproduced in other centers to treat patients who need to maintain first-line treatment.
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Affiliation(s)
- Rosalaura V Villarreal-González
- Faculty of Medicine, Oncology Service, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr José Eleuterio González", Centro Universitario Contra el Cáncer (CUCC), Monterrey, Nuevo León, México
| | - Sandra González-Díaz
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Monterrey, Nuevo León, México
| | - Oscar Vidal-Gutiérrez
- Faculty of Medicine, Oncology Service, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr José Eleuterio González", Centro Universitario Contra el Cáncer (CUCC), Monterrey, Nuevo León, México
| | - Carlos de la Cruz-de la Cruz
- Department of Internal Medicine, Universidad de Monterrey. Christus Muguerza Alta Especialidad, Monterrey, Nuevo León, México
| | - Diana C Pérez-Ibave
- Faculty of Medicine, Oncology Service, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr José Eleuterio González", Centro Universitario Contra el Cáncer (CUCC), Monterrey, Nuevo León, México
| | - María L Garza-Rodríguez
- Faculty of Medicine, Oncology Service, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr José Eleuterio González", Centro Universitario Contra el Cáncer (CUCC), Monterrey, Nuevo León, México
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Symons R, Heath F, Duggan J, Bui KT, Byun L, Friedlander M, Lee YC. Rates of paclitaxel hypersensitivity reactions using a modified Markman's infusion protocol as primary prophylaxis. Support Care Cancer 2024; 32:292. [PMID: 38632132 PMCID: PMC11023961 DOI: 10.1007/s00520-024-08460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Markman's desensitisation protocol allows successful retreatment of patients who have had significant paclitaxel hypersensitivity reactions. We aimed to reduce the risk and severity of paclitaxel hypersensitivity reactions by introducing this protocol as primary prophylaxis. METHODS We evaluated all patients with a gynaecological malignancy receiving paclitaxel before (December 2018 to September 2019) and after (October 2019 to July 2020) the implementation of a modified Markman's desensitisation protocol. The pre-implementation group received paclitaxel over a gradually up-titrated rate from 60 to 180 ml/h. The post-implementation group received paclitaxel via 3 fixed-dose infusion bags in the first 2 cycles. Rates and severity of paclitaxel hypersensitivity reactions were compared. RESULTS A total of 426 paclitaxel infusions were administered to 78 patients. The median age was 64 years (range 34-81), and the most common diagnosis was ovarian, fallopian tube and primary peritoneal cancer (67%, n = 52/78). Paclitaxel hypersensitivity reaction rates were similar in the pre-implementation (8%, n = 16/195) and post-implementation groups (9%, n = 20/231; p = 0.87). Most paclitaxel hypersensitivity reactions occurred within 30 min (pre- vs. post-implementation, 88% [n = 14/16] vs. 75% [n = 15/20]; p = 0.45) and were grade 2 in severity (pre- vs. post-implementation, 81% [n = 13/16] vs. 75% [n = 15/20]; p = 0.37). There was one grade 3 paclitaxel hypersensitivity reaction in the pre-implementation group. All patients were successfully rechallenged in the post-implementation group compared to 81% (n = 13/16) in the pre-implementation group (p = 0.43). CONCLUSION The modified Markman's desensitisation protocol as primary prophylaxis did not reduce the rate or severity of paclitaxel hypersensitivity reactions, although all patients could be successfully rechallenged.
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Affiliation(s)
- Rebecca Symons
- Royal Hospital for Women, Randwick, NSW, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Fiona Heath
- Royal Hospital for Women, Randwick, NSW, Australia
| | | | - Kim Tam Bui
- Royal Hospital for Women, Randwick, NSW, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Lily Byun
- Royal Hospital for Women, Randwick, NSW, Australia
| | - Michael Friedlander
- Royal Hospital for Women, Randwick, NSW, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Yeh Chen Lee
- Royal Hospital for Women, Randwick, NSW, Australia.
- Prince of Wales Hospital, Randwick, NSW, Australia.
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
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Bayrak Durmaz MS, Unutmaz DG, Demir M, Goksel O, Dursun AB, Bavbek S. Hypersensitivity Reactions to Taxanes: A Multicenter Study for Outcomes and Safety of Rapid Drug Desensitization. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:142-153. [PMID: 38528382 DOI: 10.4168/aair.2024.16.2.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 03/27/2024]
Abstract
PURPOSE Taxanes can cause hypersensitivity reactions (HSRs), which pose a significant challenge in the treatment of malignancies. Patients who are eligible for rapid drug desensitization (RDD) can continue treatment; however, some patients experience breakthrough reactions (BTRs). Data about risk factors for BTRs during RDDs in patients with HSRs to taxanes are limited. METHODS This was a multicenter, retrospective study of patients with immediate-HSRs to taxanes. Initial HSRs were classified as grade 1, 2, or 3 based on severity. Prick/intradermal skin tests were performed with implicated taxanes. A 12-step protocol was used during RDD. RESULTS The study comprised 75 patients (F/M: 63/12, mean age 49.92 ± 11.72 years, 43 HSRs to paclitaxel, 32 HSRs to docetaxel). The majority of reactions (86.7%) occurred during the first or second exposure. The prevalence of drug allergy history was higher in patients with paclitaxel HSR than in those with docetaxel HSR, although it was not statistically significant (23.3% vs. 6.3%). The initial HSRs were mostly grade 2 (n = 50, 66.7%) or grade 3 (n = 22, 29.3%). Skin tests with implicated taxanes were done on 48 patients, and the rate of positive response in patients with grade 1, 2, and 3 initial HSRs were 50%, 17.6%, and 16.7%, respectively. . A total of 255 RDDs were completely performed, although BTRs occurred in 27 (grade 1, 55.6%; grade 2, 40.7%; grade 3, 3.7%). There were no statistically significant correlations between the risk of BTR and age, drug cycle, gender, positivity of skin test or atopy. The step reduction was successfully done on 9 eligible patients with mild or moderate HSRs during the 12-step RDDs. CONCLUSIONS Our experience demonstrates a 100% success rate in completing the 255 RDDs for taxanes, affirming the safety and efficacy of the RDD within the study population.
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Affiliation(s)
- Makbule Seda Bayrak Durmaz
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Done Gulcin Unutmaz
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Meryem Demir
- Division of Immunology and Allergy, Department of Chest Diseases, Ege University School of Medicine, Izmir, Turkey
| | - Ozlem Goksel
- Division of Immunology and Allergy, Department of Chest Diseases, Ege University School of Medicine, Izmir, Turkey
| | - Adile Berna Dursun
- Division of Immunology and Allergy, Department of Chest Diseases, Memorial Ankara Hospital, Ankara, Turkey
- Division of Immunology and Allergy, Department of Chest Diseases, Lokman Hekim University Hospital School of Medicine, Ankara, Turkey
| | - Sevim Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey.
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Hager A, Kondle S, Agarwal A, Chintapenta M, Horadam R, Sadeghi N, Syed S. Comparative study of dexamethasone premedication regimens with docetaxel chemotherapy in early HER-2 positive breast cancer: A safety net hospital experience. J Oncol Pharm Pract 2024:10781552241232692. [PMID: 38425269 DOI: 10.1177/10781552241232692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Docetaxel can cause fluid retention reactions (FRRs) and hypersensitivity reactions (HSRs). The manufacturer recommends a multi-day oral dexamethasone premedication to prevent these toxicities, but steroid related side effects and regimen compliance remain a concern. This study aimed to determine if modified dexamethasone premedication regimens resulted in differences in HSRs or FRRs to docetaxel. We also examined side effects of dexamethasone and delays in chemotherapy. METHODS A retrospective chart review was conducted on 82 early breast cancer patients treated with docetaxel. Three steroid regimens were examined: IV 20 mg single-dose dexamethasone, or IV 12 mg dexamethasone with either dexamethasone 8 mg BID for three days starting the day before chemotherapy or dexamethasone 4 mg BID for three days following chemotherapy. Adverse effects, delays in chemotherapy, and reasons for delays in chemotherapy were recorded. RESULTS The incidence and severity of FRRs and HSRs was low, with less than 10% incidence of HSRs or FRRs in any group. Delays were most common in the group receiving dexamethasone 8 mg BID for 3 days starting the day before chemotherapy (63.3%) (p < 0.05) and were most commonly due to patient noncompliance (26%). CONCLUSION A single dose of intravenous dexamethasone alone or followed by lower doses of oral dexamethasone may improve patient compliance and avoid delays in chemotherapy, without an increase in docetaxel toxicity.
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Affiliation(s)
- Avery Hager
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Shreya Kondle
- Department of Internal Medicine, Texas Health Dallas Presbyterian Hospital, Dallas, TX, USA
| | - Amulya Agarwal
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Rochelle Horadam
- Department of Breast Medical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Navid Sadeghi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samira Syed
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Villarreal-González RV, González-Díaz S, Vidal-Gutiérrez O, Canel-Paredes A, de la Cruz-de la Cruz C, García-Campa M, López-Méndez A, Alvarado-Ruiz S, Castells M. Hypersensitivity Reactions to Taxanes: A Comprehensive and Systematic Review of the Efficacy and Safety of Desensitization. Clin Rev Allergy Immunol 2023; 65:231-250. [PMID: 37589840 DOI: 10.1007/s12016-023-08968-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/18/2023]
Abstract
Taxanes in the treatment of cancer are associated with a significant incidence of hypersensitivity reactions, which may preclude their use in patients in need of first line therapy. Drug desensitization induces transient immunological tolerance and has allowed the reintroduction of taxanes in highly allergic patients. Increase the knowledge of hypersensitivity reactions (HSR) during the administration of taxanes. A systematic review regarding the safety and efficacy of rapid drug desensitization (RDD) for taxanes HSR. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was registered in PROSPERO(CRD42021242324) and a comprehensive search was conducted in Medline, Embase, Web of Science and Scopus databases. 25 studies encompassing 10 countries were identified and 976 patients with initial HSR to paclitaxel (n = 707) and docetaxel (n = 284), that underwent a total of 2,396 desensitizations. The most common symptoms were cutaneous (74.6%) with paclitaxel and respiratory (72.6%) with docetaxel. Severe initial hypersensitivity reactions including anaphylaxis occurred in 39.6% and 13% of paclitaxel and docetaxel cases respectively and during the first (87.4%) or second exposure (81.5%). Patients tolerated well RDD and breakthrough reactions (BTR) occurred in 32.2% of paclitaxel-treated patients and in 20.6% of docetaxel treated patients. Premedications included corticosteroids, antihistamines and leukotriene receptor antagonists. The most commonly used protocol was the BWH 3 bags 12 steps, all protocols showed a success rate between 95-100%, with no reported deaths. RDD is a safe and effective procedure in patients with HSR to taxanes and protocols should be standardized for wide range implementation.
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Affiliation(s)
- Rosalaura Virginia Villarreal-González
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Oncology Service. Centro Universitario Contra el Cáncer (CUCC), Monterrey, Nuevo León, México
| | - Sandra González-Díaz
- Faculty of Medicine, Regional Center of Allergy and Clinical Immunology, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr., José Eleuterio González", Monterrey, Nuevo León, México
| | - Oscar Vidal-Gutiérrez
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Oncology Service. Centro Universitario Contra el Cáncer (CUCC), Monterrey, Nuevo León, México
| | - Alejandra Canel-Paredes
- Instituto Tecnológico de Estudios Superiores de Monterrey ITESM, Monterrey, Nuevo León, México
| | - Carlos de la Cruz-de la Cruz
- Department of Internal Medicine. Monterrey, Universidad de Monterrey. Christus Muguerza Alta Especialidad, Nuevo León, México
| | - Mariano García-Campa
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr., José Eleuterio González", Monterrey, Nuevo León, México
| | - Alfonso López-Méndez
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr., José Eleuterio González", Monterrey, Nuevo León, México
| | - Sofía Alvarado-Ruiz
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr., José Eleuterio González", Monterrey, Nuevo León, México
| | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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Seghers S, Teuwen LA, Beyens M, De Blick D, Sabato V, Ebo DG, Prenen H. Immediate hypersensitivity reactions to antineoplastic agents - A practical guide for the oncologist. Cancer Treat Rev 2023; 116:102559. [PMID: 37084565 DOI: 10.1016/j.ctrv.2023.102559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
Immediate hypersensitivity reactions (IHRs) to antineoplastic agents occur frequently, and every oncologist will encounter these reactions in their clinical practice at some point. The clinical signature of IHRs can range from mild to life-threatening, and their occurrence can substantially impede the treatment course of patients with cancer. Yet, clear guidelines regarding the diagnosis and management are scarce, especially from an oncologic point of view. Therefore, herein, we review the definition, pathophysiology, epidemiology, diagnosis and management of IHRs to chemotherapeutic agents and monoclonal antibodies. First, we focus on defining the specific entities that comprise IHRs and discuss their underlying mechanisms. Then, we summarize the epidemiology for the antineoplastic agents that represent the most common causes of IHRs, i.e., platinum compounds, taxanes and monoclonal antibodies (mAbs). Next, we describe the possible clinical pictures and the comprehensive diagnostic work-up that should be executed to identify the culprit and safe alternatives for the future. Finally, we finish with reviewing the treatment options in both the acute phase and after recovery, with the aim to improve the oncologic care of patients with cancer.
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Affiliation(s)
- Sofie Seghers
- Department of oncology, Antwerp University Hospital, Antwerp, Belgium; Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Laure-Anne Teuwen
- Department of oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Beyens
- Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of immunology, Allergology and Rheumatology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Dennis De Blick
- Department of emergency medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of immunology, Allergology and Rheumatology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Didier G Ebo
- Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of immunology, Allergology and Rheumatology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Hans Prenen
- Department of oncology, Antwerp University Hospital, Antwerp, Belgium; Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium; Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.
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Iglesias-Santamaría A, Castellano Copa P. Outcomes of a Undiluted, One-Bag Desensitization Protocol for Chemotherapeutic Agents. Ann Pharmacother 2023; 57:55-61. [PMID: 35570798 DOI: 10.1177/10600280221093594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypersensitive reactions (HSRs) often require that the provoking medication be discontinued but chemotherapeutic drugs are often essential for the treatment of the disease. Rapid drug desensitization is a procedure that induces temporary tolerance to the drug allowing continuation of treatment in patients who have presented HSRs. Most of the desensitization protocols use 3 bags with sequential dilutions of the drug, which are infused in gradual steps. However, it has not been sufficiently investigated whether dilution is essential for successful desensitization. OBJECTIVE The objective of this study was to evaluate the efficacy and safety of a new one-bag desensitization protocol which uses a single solution of 1 mg/mL throughout the procedure allowing to reduce time and simplifying the desensitization procedure. METHODS Retrospective observational study was carried out in adult patients with HSRs to chemotherapy agents who received a new nondilution one-bag desensitization protocol between 2016 and 2021. RESULTS A total of 130 desensitization procedures with an undiluted one-bag protocol were performed on 17 patients with HSRs to chemotherapy. One hundred and seven (82.3%) were for desensitization to CBDCA, 15 (11.5%) for oxaliplatin, 4 (3.1%) for paclitaxel and 4 (3.1%) for brentuximab. All of the 130 procedures were successfully accomplished, and all patients could receive their target dose. No breakthrough reactions (BTRs) occurred in 77% (100/130) of desensitizations, and only mild reactions (grade 1) with skin symptoms were observed in 23% (30/130) of desensitizations. CONCLUSION AND RELEVANCE The undiluted one-bag desensitization protocol was safe and effective and has been adopted as the standard of care at our institution in treating patients with HSRs to chemotherapeutic drugs as it requires less time and simplifies the desensitization procedure, optimizing risk management.
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Gelis S, Verdesoto JT, Pascal M, Muñoz-Cano RM. Hypersensitivity Reactions to Monoclonal Antibodies: New Approaches. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Yang BC, Castells MC. The Who, What, Where, When, Why, and How of Drug Desensitization. Immunol Allergy Clin North Am 2022; 42:403-420. [DOI: 10.1016/j.iac.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Kang SY, Seo J, Kang HR. Desensitization for the prevention of drug hypersensitivity reactions. Korean J Intern Med 2022; 37:261-270. [PMID: 35123386 PMCID: PMC8925949 DOI: 10.3904/kjim.2021.438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022] Open
Abstract
Drug desensitization is the temporary induction of tolerance to a sensitized drug by administering slow increments of the drug, starting from a very small amount to a full therapeutic dose. It can be used as a therapeutic strategy for patients with drug hypersensitivity when no comparable alternatives are available. Desensitization has been recommended for immunoglobulin E (IgE)-mediated immediate hypersensitivity; however, its indications have recently been expanded to include non-IgE-mediated, non-immunological, or delayed T cell-mediated reactions. Currently, the mechanism of desensitization is not fully understood. However, the attenuation of various intracellular signals in target cells is an area of active research, such as high-affinity IgE receptor (FcεRI) internalization, anti-drug IgG4 blocking antibody, altered signaling pathways in mast cells and basophils, and reduced Ca2+ influx. Agents commonly requiring desensitization include antineoplastic agents, antibiotics, antituberculous agents, and aspirin/nonsteroidal antiinflammatory drugs. Various desensitization protocols (rapid or slow, multi-bag or one-bag, with different target doses) have been proposed for each drug. An appropriate protocol should be selected with the appropriate concentration, dosage, dosing interval, and route of administration. In addition, the protocol should be adjusted with consideration of the severity of the initial reaction, the characteristics of the drug itself, as well as the frequency, pattern, and degree of breakthrough reactions.
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Affiliation(s)
- Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Jeongmin Seo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul,
Korea
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11
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Rapid drug desensitization with platin-based chemotherapy: Analysis of risk factors for breakthrough reactions. World Allergy Organ J 2022; 15:100619. [PMID: 34992710 PMCID: PMC8703063 DOI: 10.1016/j.waojou.2021.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background All platin-based chemotherapeutics can cause hypersensitivity reactions (HSRs). With rapid drug desensitization (RDD), few patients experience breakthrough reactions (BTR) during desensitization. However, data about risk factors for BTRs during RDD in patients with HSRs to platins are limited. We first aimed to describe characteristics of our platin-reactive population and to validate the Brigham and Women's Hospital's (BWH's) RDD protocol in our population along with their outcomes with RDD. Our second aim was to identify the risk factors for BTRs. Method This was a retrospective chart review (2013–2020) of patients with symptoms of immediate HSRs to platins. Initial HSRs were classified as grade 1, 2, or 3 based on their severity. Skin prick tests (SPT)/intradermal tests (IDT) were performed with implicated platins. A 12-step protocol was used during RDD. Results The study comprised 65 women and seven men (mean age 57.78 ± 8.73 years). Initial HSRs to carboplatin, cisplatin, and oxaliplatin occurred in 38, 13, and 21 patients, respectively. All patients reacted at the fifth (median) recurrent infusions (min:1, max:20). The median values for carboplatin, cisplatin, and oxaliplatin were 6 (1–20), 3 (1–15), and 3 (1–11), respectively. Most initial HSRs were grade 2 (n = 40, 55.6%) and 3 (n = 27, 37.5%); only 6.9% (n = 5) were grade 1. Patients with grade 1, 2, and 3 initial HSRs had positive platin skin test results at rates of 80%, 74%, and 88%, respectively. A total of 232 RDDs were performed in 72 patients and 98.7% of these desensitizations were completed. BTRs occurred in 56 (24.1%) (grade 1 n = 14, 25%; grade 2 n = 32, 57%; grade 3 n = 10, 18%) of these desensitizations. Breakthrough reactions were more severe in patients with positive SPTs or 1:100 or 1:10 dilutions of IDT (p = 0.014). BTR was not observed during RDD in any of the patients with positive 1:1 dilutions of IDT. Positivity on prick or 1:100 or 1:10 IDT increased the risk of BTR 5.058 times. There was no significant association between the risk of BTRs and age, drug cycle, sex, comorbidities, or atopy. Conclusion In our experience, 98.7% of 232 RDDs to platins were completed successfully, showing that RDD was safe and effective. Drug skin test positivity is a potential marker for identifying high-risk patients who will have BTRs during RDDs to platins.
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12
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Dubromel A, Caffin AG, Hacard F, Vantard N, Baudouin A, Herledan C, Larbre V, Schwiertz V, Nosbaum A, Pralong P, Nicolas JF, Berard F, Rioufol C, Ranchon F. Preparations of exploration of immediate hypersensitivity to antineoplastic agents: An oncology pharmacy perspective. J Oncol Pharm Pract 2021; 28:1552-1559. [PMID: 34546819 DOI: 10.1177/10781552211035695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer patients are being exposed to antineoplastic drugs more frequently and for longer periods, resulting in a higher risk of hypersensitivity reactions. The aim of this study was to assess the pharmaceutical time and direct cost of drug allergy explorations following immediate hypersensitivity reactions to antineoplastic agents. METHODS A micro-costing method was used to collect data on consumption of human and material resources for allergy exploration preparations. The monetisation was carried out on the basis of prices and hourly wage costs applied in 2018. The number and type of allergy explorations prepared by the pharmacy as well as nature of antineoplastic drugs tested, and the number of culprit drugs reintroductions were collected. RESULTS Almost 1.5 h is required to realise allergy tests for one patient including pharmacist time for prescription analysis and pharmacy technician's time for tests preparation. The mean manufacturing cost of these tests is estimated at €62.87 (€57.82-65.49) per culprit drug for one patient. Programming patients according to culprit drugs tested allows rationalising healthcare provider time and increasing efficiency. From January 2010 to December 2018, 277 patients were tested and 490 allergy explorations were performed, corresponding to more than 5000 preparations. Mostly, the culprit drug could be reintroduced (n = 383, 78.2%) allowing patients to receive the best possible treatment. CONCLUSION Management of hypersensitivity reactions is constantly progressing, as it contributes to improving patient care in oncology. This activity is time-consuming for the pharmacy team but allows patients with previous hypersensitivity reaction to continue effective treatment.
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Affiliation(s)
- Amélie Dubromel
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Anne-Gaëlle Caffin
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Florence Hacard
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France
| | - Nicolas Vantard
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Amandine Baudouin
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Chloé Herledan
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
| | - Virginie Larbre
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
| | - Vérane Schwiertz
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Audrey Nosbaum
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France
| | - Pauline Pralong
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France
| | - Jean-François Nicolas
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France.,Université Lyon 1, Inserm, U111 CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Frédéric Berard
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France.,Université Lyon 1, Inserm, U111 CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Catherine Rioufol
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
| | - Florence Ranchon
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
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13
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Shaikh SP, Nerurkar R. Adverse Drug Reaction Profile of Anticancer Agents in a Tertiary Care Hospital: An Observational Study. Curr Drug Saf 2021; 17:136-142. [PMID: 34433404 DOI: 10.2174/1574886316666210825122152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/22/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anti-cancer agents are known to be toxic, leading to a number of adverse drug reactions (ADRs). ADRs not only increase the financial burden on patient/healthcare system but also decrease quality of life. Understanding the burden of ADR will help strengthen the knowledge on patient safety and thereby in implementing intervention strategies to reduce it. OBJECTIVES 1. To study the pattern of Adverse drug reaction of anticancer agents of patients admitted in the oncology ward. 2. To assess the causality, severity, and preventability of the adverse drug reactions observed. METHODS This was a cross-sectional, observational study carried out in 200 adult patients in the daycare center for chemotherapy. Details of ADRs noted in the previous and current cycles were noted. Causality assessment was done using Naranjo and WHO scale. For severity and preventability assessment Hartwig Siegel and Modified Schumock Thorton scale were used respectively. RESULTS Out of the total 732 ADRs encountered, alopecia was the most common ADR. The average number of ADRs observed per patient was 3.66 + 1.59(mean + SD). The maximum number of ADRs were seen in Paclitaxel-carboplatin 3 weekly regimen. Nausea and alopecia were the most common ADRs reported with most regimens. On causality assessment, 95(12.97%) were definitely related according to Naranjo's Causality scale, while 15.71% were certainly related according to WHO scale. Of all the ADRs recorded,47.81% were of moderate-intensity while 52.18% were of mild intensity. The majority of ADRs were not preventable, 87.59%. CONCLUSION Alopecia was the most common ADR reported. Most of the ADRs could be causally related to drugs. These ADRs were mild to moderate in severity and were not preventable. There is need to identify the underlying factors that predispose patients to these ADRs and target them in future research.
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Affiliation(s)
- Sana Parveen Shaikh
- Department of Pharmacology, Topiwala National Medical College, Mumbai. India
| | - Rajan Nerurkar
- Department of Pharmacology, Topiwala National Medical College, Mumbai. India
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14
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Drug Desensitizations for Chemotherapy: Safety and Efficacy in Preventing Anaphylaxis. Curr Allergy Asthma Rep 2021; 21:37. [PMID: 34232411 DOI: 10.1007/s11882-021-01014-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/17/2022]
Abstract
Hypersensitivity reactions (HSRs) to antineoplastic drugs are increasing due to the expanding use of classical and new drugs in a wide variety of malignancies. PURPOSE OF REVIEW: The goal of this review is to provide current best practices in the diagnosis and management of HSRs based on data and evidence. RECENT FINDINGS: A plethora of studies have provided evidence of the safety and efficacy of rapid drug desensitizations (RDD) to allow for the reintroduction of antineoplastic drugs following an HSR, based on risk stratification. Recently described biomarkers such as basophil activation test, total IgE, BRCA genotyping, and serum IL-6 can aid in guiding improved precision desensitization protocols. Personalized premedication regimens and protocols have improved RDD safety and outcomes. RDD allows for the continued use of chemotherapeutic drugs without impaired drug efficacy. RDD represents the best approach to maintain cancer patients on their most effective treatments.
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15
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Pintea I, Petricau C, Dumitrascu D, Muntean A, Branisteanu DC, Branisteanu DE, Deleanu D. Hypersensitivity reactions to monoclonal antibodies: Classification and treatment approach (Review). Exp Ther Med 2021; 22:949. [PMID: 34335891 PMCID: PMC8290432 DOI: 10.3892/etm.2021.10381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
The present paper aims to review the topic of adverse reactions to biological agents, in terms of the incriminating mechanisms and therapeutic approach. As a result of immunomodulatory therapy, the last decade has achieved spectacular results in the targeted treatment of inflammatory, autoimmune, and neoplastic diseases, to name a few. The widespread use of biological agents is, however, associated with an increase in the number of observed adverse drug reactions ranging from local erythema to systemic reactions, including life-threatening immunologically mediated events, which justifies the need for a deeper understanding of this subject. Rapid desensitization to biological agents emerges as a treatment strategy for anaphylactic (immediate or delayed) hypersensitivity reactions as well as for severe infusion reactions. Drug desensitization is the administration of progressively increasing doses of the specific preparation until reaching the therapeutic dose in order to induce immunological tolerance and is indicated when the drugs are indispensable to the therapeutic regimen of individuals with hypersensitivity reactions to the preparation, with no reasonable alternatives.
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Affiliation(s)
- Irena Pintea
- Allergy Department, 'Professor Doctor Octavian Fodor' Regional Institute of Gastroenterology and Hepatology, 400000 Cluj-Napoca, Romania.,Allergology and Immunology Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Carina Petricau
- Allergy Department, 'Professor Doctor Octavian Fodor' Regional Institute of Gastroenterology and Hepatology, 400000 Cluj-Napoca, Romania.,Allergology and Immunology Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Dinu Dumitrascu
- Anatomy Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Adriana Muntean
- Allergy Department, 'Professor Doctor Octavian Fodor' Regional Institute of Gastroenterology and Hepatology, 400000 Cluj-Napoca, Romania.,Allergology and Immunology Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | | | - Daciana Elena Branisteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Diana Deleanu
- Allergy Department, 'Professor Doctor Octavian Fodor' Regional Institute of Gastroenterology and Hepatology, 400000 Cluj-Napoca, Romania.,Allergology and Immunology Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania.,Department of Internal Medicine Department, 'Professor Doctor Octavian Fodor' Regional Institute of Gastroenterology and Hepatology, 400000 Cluj-Napoca, Romania
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16
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Abstract
OBJECTIVES Hypersensitivity reactions (HSRs) are defined as reactions with reproducible signs and symptoms, triggered by an exposure to a stimulus at a dose tolerated by normal subjects. Although discontinuing the allergenic medication can eliminate the potential for HSRs, it can also lead to significant morbidity and mortality due to suboptimal treatment of the underlying disease. Therefore, desensitization protocols have been developed that offer a safe process that delivers full therapeutic doses in an incremental fashion without eliciting life-threatening reactions. DATA SOURCES This article uses a case study to discuss the process of chemotherapy desensitization, associated complications, and identify areas of improvement in the management of HSRs within an academic medical center. CONCLUSION HSRs are a complex pathophysiologic response that requires an experienced oncology nurse at the bedside to manage potentially life-threatening symptoms. IMPLICATIONS FOR NURSING PRACTICE Thorough education and training is needed among nursing staff to manage HSRs during the chemotherapy desensitization process.
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17
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Stockton W, Lam F, Nguyen T, Nguyen T, Kirov I. Six-step etoposide desensitization protocol: A pediatric, adolescent, and young adult case series. Pediatr Blood Cancer 2021; 68:e28795. [PMID: 33155419 DOI: 10.1002/pbc.28795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 11/08/2022]
Abstract
Etoposide administration can be complicated by hypersensitivity reactions. Desensitization may provide a strategy to prevent hypersensitivity recurrence. One challenge with desensitization is regimen complexity. This case series describes 12 pediatric, adolescent, and young adult patients who received a simplified six-step etoposide desensitization protocol. This protocol contains 50% fewer titration steps compared with previously described protocols and eliminates infusion rate changes during titration. Simplified titration may minimize risk of error during administration and improve safety. This protocol was tolerated by 92% of patients. Given increasing frequency and duration of drug shortages, a simplified desensitization protocol provides a valuable treatment option.
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Affiliation(s)
- Winifred Stockton
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Fionna Lam
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Theresa Nguyen
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Tran Nguyen
- Department of Pharmacy, Children's Hospital of Orange County, Orange, California
| | - Ivan Kirov
- Division of Oncology, Hyundai Cancer Institute, Children's Hospital of Orange County, Orange, California
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18
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Current Immunotherapy Approaches in Non-Hodgkin Lymphomas. Vaccines (Basel) 2020; 8:vaccines8040708. [PMID: 33260966 PMCID: PMC7768428 DOI: 10.3390/vaccines8040708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022] Open
Abstract
Non-Hodgkin lymphomas (NHLs) are lymphoid malignancies of B- or T-cell origin. Despite great advances in treatment options and significant improvement of survival parameters, a large part of NHL patients either present with a chemotherapy-refractory disease or experience lymphoma relapse. Chemotherapy-based salvage therapy of relapsed/refractory NHL is, however, capable of re-inducing long-term remissions only in a minority of patients. Immunotherapy-based approaches, including bispecific antibodies, immune checkpoint inhibitors and genetically engineered T-cells carrying chimeric antigen receptors, single-agent or in combination with therapeutic monoclonal antibodies, immunomodulatory agents, chemotherapy or targeted agents demonstrated unprecedented clinical activity in heavily-pretreated patients with NHL, including chemotherapy-refractory cases with complex karyotype changes and other adverse prognostic factors. In this review, we recapitulate currently used immunotherapy modalities in NHL and discuss future perspectives of combinatorial immunotherapy strategies, including patient-tailored approaches.
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19
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20
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Allergy Evaluation of Hypersensitivity to Platinum Salts and Taxanes: A Six-Year Experience. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1658-1664. [DOI: 10.1016/j.jaip.2019.12.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 01/27/2023]
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21
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Caiado J, Brás R, Paulino M, Costa L, Castells M. Rapid desensitization to antineoplastic drugs in an outpatient immunoallergology clinic: Outcomes and risk factors. Ann Allergy Asthma Immunol 2020; 125:325-333.e1. [PMID: 32353405 DOI: 10.1016/j.anai.2020.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/05/2020] [Accepted: 04/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hypersensitivity reactions to antineoplastic agents may lead to discontinuation of first-line treatments. Rapid drug desensitization (RDD) allows for a safe reintroduction in patients who are allergic to them. OBJECTIVE To evaluate the safety and efficacy of the Brigham and Women's Hospital's 12-step RDD in a Portuguese patient population with cancer and to identify markers associated with breakthrough reactions (BTRs) to platins. METHODS We conducted a retrospective review of desensitizations undertaken at the Immunoallergology Day-Care Unit of the Santa Maria Hospital in Lisbon, Portugal, from July 2008 to July 2019. Adult patients with cancer and with immediate hypersensitivity reactions were included. Skin testing was performed to platins, trastuzumab, and cetuximab. The 12-step protocol was used for most patients, and a shorter protocol was used in 9 patients who were taxane-reactive to resume regular infusions. RESULTS A total of 1471 RDDs were performed in 272 patients to 136 platins, 124 taxanes, 13 monoclonal antibodies, and 10 other drugs. Skin test results were positive in 127 of patients who were platin-reactive (95.3%) and negative in patients who were cetuximab- and trastuzumab-reactive. There were 141 BTRs during RDD (9.6% of infusions), 79.4% induced by platins with the majority having mild reactions (68.8%). There were 8 patients who were paclitaxel-reactive, and who completed a shorter protocol and resumed regular infusions successfully. Multiple platin infusions (cutoff: ≥10) and total immunoglobulin E greater than or equal to 100 U/mL were identified as independent risk factors for BTRs in patients who were platin-reactive. CONCLUSION This large single-center study confirmed the safety and efficacy of the 12-step RDD protocol in a diverse cancer population, providing evidence of its universal applications. Total immunoglobulin E is a potentially useful biomarker to identify high-risk patients who are platin-reactive.
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Affiliation(s)
- Joana Caiado
- Immunoallergology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria Hospital, Lisboa, Portugal.
| | - Rita Brás
- Immunoallergology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria Hospital, Lisboa, Portugal
| | - Marisa Paulino
- Immunoallergology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria Hospital, Lisboa, Portugal
| | - Luis Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria Hospital, Lisboa, Portugal
| | - Mariana Castells
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Kim HH, Moon M, Cho MK, Ahn KM, Chung S, Kang DY, Lee SY, Cho SH, Kang HR. Comparison of one-bag and multibag desensitization protocols for the prevention of rituximab hypersensitivity. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.3.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hyun Hwa Kim
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Mira Moon
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Min Kyoung Cho
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Min Ahn
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soojie Chung
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Yoon Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Suh Young Lee
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Ryun Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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23
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Babaie D, Shamsian BS, Momtazmanesh N, Godarzipour H, Amirmoini M, Bashardoust B, Ebrahimi M, Vahedi M, Ghaemi R, Mesdaghi M. Rapid Desensitization for Hypersensitivity Reactions to Chemotherapeutic Drugs; A Case Series. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2019; 18:1047-1051. [PMID: 31531085 PMCID: PMC6706720 DOI: 10.22037/ijpr.1999.1100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Delara Babaie
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bibi Shahin Shamsian
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Momtazmanesh
- Department of Pediatric Hematology and Oncology, Loghman-e- Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Godarzipour
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Amirmoini
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Bashardoust
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Ebrahimi
- Department of Pediatrics, Loghman-e- Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Vahedi
- Department of Pediatrics, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Ghaemi
- Department of Pediatrics, Urmia University of Medical Sciences, Urmia, Iran
| | - Mehrnaz Mesdaghi
- Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Stockton WM, Nguyen T, Zhang L, Dowling TC. Etoposide and etoposide phosphate hypersensitivity in children: Incidence, risk factors, and prevention strategies. J Oncol Pharm Pract 2019; 26:397-405. [DOI: 10.1177/1078155219858390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Etoposide is critical in treating pediatric cancers, although hypersensitivity can be severe and treatment-limiting. Reported rates of hypersensitivity range from 2% to 51%. Hypersensitivity data for etoposide phosphate, a newer product, are lacking. The primary objective of this study was to assess etoposide and etoposide phosphate hypersensitivity incidence. Secondary objectives included evaluation of potential risk factors for hypersensitivity and strategies to prevent recurrence. Methods This retrospective cohort study evaluated pediatric patients who received initial etoposide phosphate or etoposide dose between August 2012 and July 2017. The primary outcome was documentation of hypersensitivity within four months of initial dose. Potential risk factors evaluated included age, allergies, dose, infusion rate, infusion concentration, and premedication. Results Of 246 patients, hypersensitivity reactions occurred in five of 54 patients (9.3%) who received etoposide phosphate and 52 of 192 patients (27.1%) who received etoposide ( p = 0.0061). For etoposide, the mean initial infusion rate was 64.6 ± 40.9 mg/m2/h for patients with hypersensitivity and 49.5 ± 33.4 mg/m2/h without hypersensitivity ( p = 0.0886). Etoposide phosphate rate was not associated with hypersensitivity. Recurrent hypersensitivity occurred in one of nine patients (11.1%) who received etoposide desensitization and one of 38 patients (2.6%) who changed formulation to etoposide phosphate. Conclusions Etoposide was associated with more hypersensitivity than etoposide phosphate in pediatric patients. Etoposide hypersensitivity was associated with higher infusion rates, but not etoposide phosphate. Differences in hypersensitivity incidence and infusion rate influence indicate a formulation-effect. Etoposide hypersensitivity recurrence may be prevented by changing to etoposide phosphate formulation. During etoposide phosphate shortages, etoposide desensitization may prevent recurrent hypersensitivity.
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Affiliation(s)
- Winifred M Stockton
- Children's Hospital of Orange County, Department of Pharmacy, Orange, CA, USA
| | - Theresa Nguyen
- Children's Hospital of Orange County, Department of Pharmacy, Orange, CA, USA
| | - Lishi Zhang
- Biostatistics, Institute for Clinical and Translational Science, University of California, Irvine, CA, USA
| | - Thomas C Dowling
- Ferris State University, College of Pharmacy, Big Rapids, MI, USA
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Laudati C, Clark C, Knezevic A, Zhang Z, Barton-Burke M. Hypersensitivity Reactions: Priming Practice Change to Reduce Incidence in First-Dose Rituximab Treatment. Clin J Oncol Nurs 2018; 22:407-414. [DOI: 10.1188/18.cjon.407-414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Options in Hypersensitivity Reactions to Chemotherapeutics. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Giavina-Bianchi P, Patil SU, Banerji A. Immediate Hypersensitivity Reaction to Chemotherapeutic Agents. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:593-599. [DOI: 10.1016/j.jaip.2017.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/20/2017] [Accepted: 03/21/2017] [Indexed: 01/01/2023]
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28
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Roper K, Siefert ML, Fuller F, Lucier D, Berry DL. Self-Administered Premedication: Improving Taxane Chemotherapy Treatment
. Clin J Oncol Nurs 2017; 21:234-239. [PMID: 28315538 DOI: 10.1188/17.cjon.234-239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients receiving taxane therapy are at risk for hypersensitivity reactions without appropriate premedication management. Patients must understand the importance of taking premedications as prescribed to prevent reactions.
. OBJECTIVES The objectives of this study were to implement and evaluate a multidisciplinary practice protocol comprised of standardized nursing documentation of premedication regimens, teaching, and patient adherence to at-home premedication in an electronic health record (EHR).
. METHODS A new process was developed to provide standardized prescriptions, a personalized instruction sheet for patients and families, and a standardized approach to document adherence and teaching in the EHR. Pre- and post-EHR audits were used twice to evaluate the practice changes.
. FINDINGS The findings of the first audit suggested improvement in all practice changes. After the first audit, reinforcement of the changes occurred within the group and with one-on-one meetings. The goal of 90% adherence was met at the second audit.
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29
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Jakel P, Carsten C, Braskett M, Carino A. Nursing Care of Patients Undergoing Chemotherapy Desensitization: Part I. Clin J Oncol Nurs 2017; 20:29-32. [PMID: 26800403 DOI: 10.1188/16.cjon.29-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypersensitivity reactions to chemotherapeutic agents can cause the discontinuation of first-line therapies. Chemotherapy desensitization is a safe, but labor-intensive, process to administer these important medications. A desensitization protocol can enable a patient to receive the entire target dose of a medication, even if the patient has a history of severe infusion reactions. In this article, the authors explain the pathophysiology of hypersensitivity reactions and describe the recent development of desensitization protocols in oncology. In part II of this article, which will appear in the April 2016 issue of the Clinical Journal of Oncology Nursing, the authors will give a detailed account of how a desensitization protocol is performed at an academic medical center.
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Giavina-Bianchi P, Galvão VR, Picard M, Caiado J, Castells MC. Basophil Activation Test is a Relevant Biomarker of the Outcome of Rapid Desensitization in Platinum Compounds-Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:728-736. [PMID: 28034549 DOI: 10.1016/j.jaip.2016.11.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/30/2016] [Accepted: 11/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rapid drug desensitization (RDD) has become a cornerstone in the management of immediate drug hypersensitivity reactions (DHRs) to chemotherapeutic agents. Because of the inherent risk of anaphylaxis during RDD, biomarkers to predict patients at risk of developing such severe reactions are needed. The basophil activation test (BAT) has been used in DHRs as a diagnostic tool. OBJECTIVE We evaluated basophil CD63 and CD203c expression (BAT) as a biomarker to assess the safety and effectiveness of RDD in platinum compounds-allergic patients. METHODS Patients allergic to platinum compounds (n = 15) undergoing RDD were assessed through clinical history, skin testing, serum tryptase levels, and BAT. BAT was performed immediately before RDD, assessing CD203c and CD63 expression on basophils. BAT was also performed in 6 patients tolerant to platinum compounds and in 6 healthy volunteers. RESULTS BAT was positive to CD203c or CD63 in 11 out of 15 patients allergic to platinum compounds (73%), with increased expression of CD203c and CD63 in 11 (73%) and 6 (40%) patients, respectively. Increased CD63 expression tended to be associated with more severe initial reactions. All controls had negative test results. Reactions during RDD were associated with BAT positivity and increased tryptase levels. Only 1 of 4 patients with negative BAT had a mild reaction during RDD. BAT remained positive in multiple sequential RDD. CONCLUSIONS BAT identified patients allergic to platinum compounds with an increased risk of reactions during desensitization and higher CD63 expression was observed in severe reactions. Multiple RDDs to platinum compounds did not induce persistent hyporesponsiveness on basophils. BAT is a potential biomarker for RDD.
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Affiliation(s)
- Pedro Giavina-Bianchi
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
| | - Violeta Régnier Galvão
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Matthieu Picard
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Canada
| | - Joana Caiado
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Immunoallergology Department, Hospital de Santa Maria/Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Mariana C Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Minhas JS, Wickner PG, Long AA, Banerji A, Blumenthal KG. Immune-mediated reactions to vancomycin: A systematic case review and analysis. Ann Allergy Asthma Immunol 2016; 116:544-53. [PMID: 27156746 PMCID: PMC4946960 DOI: 10.1016/j.anai.2016.03.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/17/2016] [Accepted: 03/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vancomycin is a broad-spectrum antibiotic whose use may be limited by adverse drug reactions (ADRs). Although vancomycin toxic effects are known, there are limited data on vancomycin hypersensitivity reactions (HSRs). OBJECTIVE To understand the most commonly reported vancomycin HSRs through systematic case review. METHODS We performed a literature search for English-language case reports and series from 1982 through 2015 (last search July 31, 2015) on Ovid MEDLINE and PubMed. The search included the subject heading vancomycin with the subheading adverse effects and separate text searches for vancomycin with a list of specified HSRs. References of identified articles were reviewed to find additional articles. Clinical data were collected and summarized. RESULTS Of 201 identified articles, 84 were screened and 57 fully assessed; these 57 articles contained 71 vancomycin HSR cases that were included in analysis. Vancomycin HSRs were immediate (anaphylaxis, n = 7) and nonimmediate (n = 64). Nonimmediate HSRs included linear IgA bullous dermatosis (LABD, n = 34), drug rash eosinophilia and systemic symptoms (DRESS) syndrome (n = 16), acute interstitial nephritis (AIN, n = 8), and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN, n = 6). Median times of vancomycin therapy before HSR onset was 7 days (interquartile range [IQR], 4-10 days) for LABD, 9 days (IQR, 9-22 days) for SJS/TEN, 21 days (IQR, 17-28 days) for DRESS syndrome, and 26 days (IQR, 7-29 days) for AIN. Overall, 11 patients (16%) died, and 4 (6%) had deaths attributed to the HSR. CONCLUSION Vancomycin causes a variety of HSRs; the most commonly identified were nonimmediate HSRs, with LABD being most frequent. We observed a high frequency of HSR mortality. Further data are needed to understand the frequency and severity of vancomycin HSRs.
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Affiliation(s)
- Jasmit S Minhas
- Department of Medicine, Lahey Clinic, Burlington, Massachusetts.
| | - Paige G Wickner
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Aidan A Long
- Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Aleena Banerji
- Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kimberly G Blumenthal
- Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts
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Maladie de Castleman : désensibilisation rapide après une réaction d’hypersensibilité au rituximab. Rev Med Interne 2016; 37:433-6. [DOI: 10.1016/j.revmed.2015.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/04/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022]
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Abstract
Hypersensitivity reactions are increasingly prevalent, although underrecognized and underreported. Platins induce immunoglobulin E-mediated sensitization; taxenes and some monoclonal antibodies can induce reactions at first exposure. Severe hypersensitivity can preclude first-line therapy. Tryptase level at the time of a reaction is a useful diagnostic tool. Skin testing provides a specific diagnosis. Newer tests are promising diagnostic tools to help identify patients at risk before first exposure. Safe management includes rapid drug desensitization. This review provides information regarding the scope of hypersensitivity and anaphylactic reactions induced by chemotherapy and biological drugs, as well as diagnosis, management, and treatment options.
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Affiliation(s)
- Mariana C Castells
- Allergy Immunology Training Program, Drug Hypersensitivity and Desensitization Center, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, 1 Jimmy Fund Way, Boston, MA 02115, USA.
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Garcia Escallon S, Muniyappa PK, Subramanian S. Successful rapid desensitization to intravenous etoposide using a 14-step protocol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:627-8. [DOI: 10.1016/j.jaip.2014.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022]
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Giavina-Bianchi P, Aun MV, Galvão VR, Castells M. Rapid Desensitization in Immediate Hypersensitivity Reaction to Drugs. CURRENT TREATMENT OPTIONS IN ALLERGY 2015. [DOI: 10.1007/s40521-015-0060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The success of antibody therapy in cancer is consistent with the ability of these molecules to activate immune responses against tumors. Experience in clinical applications, antibody design, and advancement in technology have enabled antibodies to be engineered with enhanced efficacy against cancer cells. This allows re-evaluation of current antibody approaches dominated by antibodies of the IgG class with a new light. Antibodies of the IgE class play a central role in allergic reactions and have many properties that may be advantageous for cancer therapy. IgE-based active and passive immunotherapeutic approaches have been shown to be effective in both in vitro and in vivo models of cancer, suggesting the potential use of these approaches in humans. Further studies on the anticancer efficacy and safety profile of these IgE-based approaches are warranted in preparation for translation toward clinical application.
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Affiliation(s)
- Lai Sum Leoh
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 54-140, Box 951782, Los Angeles, CA 90095-1782, USA
| | - Tracy R. Daniels-Wells
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 54-140, Box 951782, Los Angeles, CA 90095-1782, USA
| | - Manuel L. Penichet
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 54-140, Box 951782, Los Angeles, CA 90095-1782, USA. Department of Microbiology, Immunology, and Molecular Genetics, University of California, 609 Charles E. Young Dr. East, 1602 Molecular Science Building, Los Angeles, CA 90095, USA. The Jonsson Comprehensive Cancer Center, University of California, 10833 Le Conte Ave, 8-684 Factor Building, Box 951781, Los Angeles, CA 90095, USA. The Molecular Biology Institute, University of California, 611 Charles E. Young Dr., Los Angeles, CA 90095, USA
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Caiado J, Picard M. Diagnostic Tools for Hypersensitivity to Platinum Drugs and Taxanes: Skin Testing, Specific IgE, and Mast Cell/Basophil Mediators. Curr Allergy Asthma Rep 2014; 14:451. [DOI: 10.1007/s11882-014-0451-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Picard M, Castells MC. Re-visiting Hypersensitivity Reactions to Taxanes: A Comprehensive Review. Clin Rev Allergy Immunol 2014; 49:177-91. [DOI: 10.1007/s12016-014-8416-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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