A Large Single-Hospital Experience Using Drug Provocation Testing and Rapid Drug Desensitization in Hypersensitivity to Antineoplastic and Biological Agents.

Abstract

BACKGROUND:

Large-scale studies of drug provocation testing (DPT) or rapid drug desensitization (RDD) for hypersensitivity to antineoplastics and biologicals are scarce and limited to a few institutions.

OBJECTIVE:

Our aim was to review our experience with DPT and RDD in a large number of patients with a history of hypersensitivity to antineoplastics and biologicals and summarize the practical implications of that experience.

METHODS:

This was a 7-year prospective, observational, longitudinal study with reactive patients referred to the Desensitization Program at Ramon y Cajal University Hospital (RCUH). Patients were selected after following our systematic and validated diagnostic approach (clinical history, skin test, risk assessment, specific IgE, DPT) before RDD. Candidate patients underwent RDD using the RCUH protocol. Cetuximab reactors underwent 1-bag RDDs.

RESULTS:

A total of 1027 intravenous RDDs were performed using the RCUH protocol (399 platins, 395 taxanes, 178 biologicals, 55 other drugs), and 1026 were successfully accomplished in the 186 patients (of 515 referred patients) who met inclusion criteria for RDD. No breakthrough reactions occurred in 88% of RDDs. Most breakthrough reactions were mild. A total of 341 DPTs were performed, and 229 results were negative (67%). DPTs helped exclude hypersensitivity in 44% (229 of 515) of referred patients. In addition, 77 one-bag RDDs were performed in 6 cetuximab-reactive patients.

CONCLUSIONS:

This experience allows us to describe general management plans, as well as specific patient phenotypic patterns, predictors for reactions, and risk considerations that need a tailored approach (taking into account the 3 prominent drug categories: platins, taxanes, and biologicals).

• Authors: Ricardo Madrigal-Burgaleta, Lorena Bernal-Rubio, Maria Pilar Berges-Gimeno, Laura Victoria Carpio-Escalona, Patricia Gehlhaar, Emilio Alvarez-Cuesta
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) Vol. 7 Issue 2 Pg. 618-632 (02 2019) ISSN: 2213-2201 [Electronic] United States
• PMID: 30098410 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Biological Products
• Platinum Compounds
• Taxoids

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (administration & dosage, adverse effects)
• Biological Products (administration & dosage, adverse effects)
• Desensitization, Immunologic
• Drug Hypersensitivity (diagnosis, therapy)
• Female
• Hospitals
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Phenotype
• Platinum Compounds (adverse effects)
• Prospective Studies
• Taxoids (adverse effects)
• Young Adult