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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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Barni S, Mori F, Valleriani C, Mangone G, Testi S, Saretta F, Sarti L, Pucci N, de Martino M, Azzari C, Novembre E. The utility of the basophil activation test in the diagnosis of immediate amoxicillin or amoxicillin-clavulanate hypersensitivity in children and adults. Ital J Pediatr 2017; 43:42. [PMID: 28431585 PMCID: PMC5401564 DOI: 10.1186/s13052-017-0360-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background The basophil activation test (BAT), has been proposed as a possible assay for the diagnosis of immediate-type allergy to beta-lactams (BLs). The aim of this study was to assess the utility of BAT in the diagnosis of amoxicillin (AMX) or AMX-clavulanate (AMX-C) IgE-mediated hypersensitivity in children and adults. Material and methods Eighteen children and 21 adults, with clinical history of immediate reactions to AMX or AMX-C, were referred to Anna Meyer Children’s Hospital and San Giovanni di Dio Hospital, respectively. They underwent in vivo tests (skin prick test and intradermal test). Moreover, BAT with AMX or AMX-C was performed within 6 months from the reaction. Results In the pediatric group, the concordance between the skin tests (ST) and BAT results was 83.3%. Upon comparing the symptom grades and ST results to the BAT results, we found that the reaction severity and ST positivity did not correlate with BAT results in children. In the adult group, the concordance between the ST and BAT results was 61.9%. Upon comparing patients with severe reactions and patients with mild reactions in terms of BAT results, we found a BAT sensitivity of 38.5% and a specificity of 100%. When comparing the symptom grades to the BAT results, we found that no patients with mild symptoms had a positive BAT result, whereas 38.5% of patients with severe symptoms had a positive BAT result. Conclusions BAT does not seem to be a useful tool to increase the sensitivity of an allergy work-up to diagnose immediate hypersensitivity to AMX or AMX-C.
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Affiliation(s)
- Simona Barni
- Allergy Unit, A. Meyer Children's Hospital, University of Florence, Viale Pieraccini, 24, 50134, Florence, Italy.
| | - Francesca Mori
- Allergy Unit, A. Meyer Children's Hospital, University of Florence, Viale Pieraccini, 24, 50134, Florence, Italy
| | - Claudia Valleriani
- Departments of Paediatrics, A. Meyer's Children Hospital, Viale Pieraccini, 24, 50139, Florence, Italy
| | - Giusi Mangone
- Departments of Paediatrics, A. Meyer's Children Hospital, Viale Pieraccini, 24, 50139, Florence, Italy
| | - Sergio Testi
- Allergy and Clinical Immunology Unit, San Giovanni di Dio's Hospital, Florence, Italy
| | - Francesca Saretta
- Departments of Paediatrics, A.A.S 2 Bassa Friulana Palmanova's Hospital, Udine, USA
| | - Lucrezia Sarti
- Allergy Unit, A. Meyer Children's Hospital, University of Florence, Viale Pieraccini, 24, 50134, Florence, Italy
| | - Neri Pucci
- Allergy Unit, A. Meyer Children's Hospital, University of Florence, Viale Pieraccini, 24, 50134, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Chiara Azzari
- Departments of Paediatrics, A. Meyer's Children Hospital, Viale Pieraccini, 24, 50139, Florence, Italy
| | - Elio Novembre
- Allergy Unit, A. Meyer Children's Hospital, University of Florence, Viale Pieraccini, 24, 50134, Florence, Italy
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Anaphylaxis to the amoxicillin skin prick test: utility of the basophil activation test in diagnosis. Ann Allergy Asthma Immunol 2016; 116:259-60. [PMID: 26803535 DOI: 10.1016/j.anai.2015.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/21/2022]
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Leysen J, Sabato V, Verweij MM, De Knop KJ, Bridts CH, De Clerck LS, Ebo DG. The basophil activation test in the diagnosis of immediate drug hypersensitivity. Expert Rev Clin Immunol 2014; 7:349-55. [DOI: 10.1586/eci.11.14] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chirumbolo S. Basophil Activation Test in Allergy: Time for an Update? Int Arch Allergy Immunol 2012; 158:99-114. [DOI: 10.1159/000331312] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/29/2011] [Indexed: 11/19/2022] Open
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Ebo DG, Leysen J, Mayorga C, Rozieres A, Knol EF, Terreehorst I. The in vitro diagnosis of drug allergy: status and perspectives. Allergy 2011; 66:1275-86. [PMID: 21645014 DOI: 10.1111/j.1398-9995.2011.02661.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adverse drug reactions (ADR) can result from immune-mediated (drug allergy) and nonimmune-mediated mechanisms. In both types of reaction, conclusive diagnosis and appropriate management remain major problems in daily clinical practice. This review summarizes the potentials and shortcomings of the currently available in vitro tests in the diagnosis of immediate (mostly IgE mediated) and nonimmediate (mostly T-cell mediated) drug allergy, particularly quantification of specific IgE, flow-assisted analysis of in vitro activated lymphocytes and basophils and the enzyme-linked immunosorbent spot.
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Affiliation(s)
- D G Ebo
- Faculty of Medicine, Department of Immunology, Allergology and Rheumatology, University Antwerp, Antwerpen, Belgium.
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Abstract
Cellular in-vitro assays are able to detect antigen-dependent cellular processes without any risk for the patient. After antigen stimulation, both the cellular antigen stimulation test assessing sulfidoleukotriene production in leukocyte suspension, and flow cytometric basophil activation assays determining surface activation markers (CD63, CD203c), represent accepted models for in-vivo mast cell stimulation particularly in IgE-dependent reactions of immediate type. The value of these assays should be estimated considering the type of antigen and further diagnostic options. Most studies can not be compared due to different allergen concentrations, conditions of stimulation, methods, and defined cut-offs. Therefore, it is difficult to evaluate published evidence. Because of the logistic effort, cellular assays are often available only in specialized laboratories. However, in daily routine they are important in cases with clear-cut history but negative conventional allergy diagnostic procedures, in case of rare allergens (drugs, exotic food), as well as contraindications for skin and/or provocation test (hymenoptera venom allergy, anaphylaxis).
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Affiliation(s)
- B Wedi
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Ricklinger Str. 5, 30449, Hannover.
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Pinnobphun P, Buranapraditkun S, Kampitak T, Hirankarn N, Klaewsongkram J. The diagnostic value of basophil activation test in patients with an immediate hypersensitivity reaction to radiocontrast media. Ann Allergy Asthma Immunol 2011; 106:387-93. [PMID: 21530870 DOI: 10.1016/j.anai.2010.12.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 12/22/2010] [Accepted: 12/28/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND No available test diagnoses allergic reactions to radiocontrast media (RCM). The basophil activation test (BAT) has been introduced for the diagnosis of both immunoglobulin (Ig) E and non-IgE-dependent mast cell degranulation, but its value to diagnose immediate RCM reactions is still unknown. OBJECTIVE This study aims to evaluate the diagnostic value of BAT in immediate RCM hypersensitivity. METHODS The BATs were performed in 26 patients with immediate RCM reactions and in 43 specimens from healthy volunteers. The sample's whole blood was incubated with the responsible RCM and % activated (CD63+/CCR3+) basophils were analyzed by flow cytometry. Receiver operating characteristics (ROC) curve analysis was performed to calculate the optimal cutoff value of activated basophils to diagnose patients with RCM hypersensitivity. RESULTS The incubation of blood with RCM yielded significantly higher activated basophil percentages in patients with a history of immediate RCM reactions than in normal controls with both 1:100 and 1:10 dilutions (13.11% vs. 2.71%, P value = .01; and 19.23% vs. 3.73%, P = .001, respectively). Both % activated basophils and stimulation index (SI) had acceptable discrimination powers to diagnose RCM hypersensitivity. The area under the curve was 0.79 (95% CI 0.67-0.91, P = .000) by using SI as the diagnostic criteria with 1:100 dilution of RCM. The specificity of the test ranged from 88.4% to 100%. CONCLUSION Our study demonstrated the potential of BAT as a diagnostic tool for an immediate RCM hypersensitivity, particularly as a confirmation test. Further studies are required to confirm the test accuracy and identify a patient's predisposing factors.
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Affiliation(s)
- Panwas Pinnobphun
- Medical Microbiology, Interdisciplinary Program, Graduate School Chulalongkorn University, Bangkok, Thailand
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De Knop KJ, Bridts CH, Verweij MM, Hagendorens MM, De Clerck LS, Stevens WJ, Ebo DG. Component-resolved allergy diagnosis by microarray: potential, pitfalls, and prospects. Adv Clin Chem 2010; 50:87-101. [PMID: 20521442 DOI: 10.1016/s0065-2423(10)50005-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diagnosis of IgE-mediated allergies is not always straightforward, as traditional tests can yield equivocal or negative results and provocation tests are hampered by several practical and ethical limitations. During the last decades two new in vitro techniques have entered the field of allergy diagnosis, that is, flow-assisted analysis of allergen-specific activated basophils and component-resolved diagnosis (CRD). This review focuses on component-resolved allergy diagnosis by microarray that has evolved from recent advances in molecular allergology and biochip technology. The technique allows a comprehensive analysis of individual sensitization profiles with multiplexed purified and recombinant allergens within a single run using only a minute amount of serum, providing information that largely exceeds the output from current sIgE capturing tools. Actually, multiplexing allows identification of diagnostic patterns that may facilitate the formulation of diagnostic algorithms. Although CRD by microarray sounds promising, the diagnostic performance requires further intensive assessment before it can enter mainstream application. In our opinion, the technique should currently be considered a complementary diagnostic tool rather than a first-line choice.
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Affiliation(s)
- K J De Knop
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine, University of Antwerp, Antwerpen, Belgium
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Almqvist C, Bradding PB, Chakir J, Ebo D, Grattan C, Kariyawasam HH, Savilahti E, Scadding GK, Vieths S, Wardlaw AJ, Woodfolk J. Developments in the field of allergy in 2008 through the eyes of Clinical & Experimental Allergy. Clin Exp Allergy 2010; 39:1482-98. [PMID: 19954428 DOI: 10.1111/j.1365-2222.2009.03355.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In 2008, many thousands of articles were published on the subject of allergic disease with over 200 reviews, editorials and original papers in Clinical & Experimental Allergy alone. These represent a considerable amount of data and even the most avid reader could only hope to assimilate a small fraction of this knowledge. There is therefore a pressing need for the key messages that emerge from a journal such as Clinical & Experimental Allergy to be summarized by experts in the field in a form that highlights the significance of the developments and sets them in the context of important findings in the field published in other journals. This also has the advantage of making connections between new data in conditions such as asthma, where articles often appear in different sections of the journal. As can be seen from this review, the body of work is diverse both in terms of the disease of interest and the discipline that has been used to investigate it. However, taken as a whole, we hope that the reader will gain a flavour of where the field is mature, where there remain controversies and where the cutting edge is leading.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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