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JACI Highlights - May 2008
Hypersensitivity reactions to chemotherapy: Outcomes and safety of rapid desensitization in 413 cases
Mariana C. Castells, MD, PhD, Nichole M. Tennant, BA, David E. Sloane, MD, F. Ida Hsu, MD, Nora A. Barrett, MD, David I. Hong, MD, Tanya M. Laidlaw, MD, Henry J. Legere, MD, Samridhi N. Nallamshetty, MD, Ross I. Palis, MD, Jayanti J. Rao, MD, Suzanne T. Berlin, DO, Susana M. Campos, MD, and Ursula A. Matulonis, MD.
Some cancer patients have developed hypersensitivity reactions (allergic reactions) to their chemotherapy treatments. This adds significantly stress for the patient and raises a dilemma for caregivers: should the drug be continued, even though further use could cause a severe, even fatal, allergic reaction? Or, should alternative drugs be used, even though they may be poorly tolerated or much less effective in fighting the malignancy than the first drug? In a study published in the Journal of Allergy and Clinical Immunology, Castells et al describe a procedure, a rapid desensitization protocol, they developed for helping patients achieve temporary tolerance to chemotherapy drugs. In twelve steps over a 6 to 8 hour period, the patients were given intravenous or intraperitoneal infusions with increasing concentrations of the allergy-producing chemotherapy drug until the target concentration was reached. Of the ninety-eight patients studied during a total of 413 desensitizations, 94% had no reaction or only a mild one. Those who did have reactions were successfully controlled; there were no life-threatening hypersensitivity reactions or deaths during these procedures. All the patients received the full desensitization dose, allowing them to continue receiving the critically important medications in their cancer treatment. The chemotherapeutic drugs successfully desensitized in this study were carboplatin, cisplatin, oxaliplatin, paclitaxel, pegylated doxorubicin, adriamycin and rituximab. Two patients were even treated for double hypersensitivities. The authors' research demonstrates that their 12-step rapid drug desensitization protocol is safe and effective. It must be administered by an allergist/immunologist who has experience in drug desensitization, but it offers a powerful tool for using preferred treatment agents in patients battling cancer.
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