Outcomes and safety of rapid desensitization for chemotherapy hypersensitivity

Abstract

Importance of the field: The incidence of hypersensitivity reactions (HSRs) to chemotherapy agents has increased because of increasing number of cancer survivors are exposed to repeated courses of sensitizing agents. Replacement with an alternative chemotherapy regimen is often limited by tumor sensitivity. Rapid desensitization offers an effective mean to allow continuation of the treatment to which patients have presented HSRs.

Areas covered in this review: We review the methods, outcome and safety of the rapid desensitization protocol developed at Brigham and Women's Hospital, Harvard Medical School Affiliate, based on our recent publication “‘Hypersensitivity reactions to chemotherapy: outcome and safety of rapid desensitization in 413 cases”. Literature search was conducted through Medline (from January 1976 to September 2009), using PubMed.

What the reader will gain: The article will give insight to clinical manifestations of immediate HSR to various chemotherapy agents and their presumably different immunopathomechanism. Risk assessment, including skin testing in those presented HSRs to platins and details on rapid desensitization process and its pitfalls will be discussed.

Take home message: Standa"rd protocol of rapid desensitization, administering under multidisciplinary team approach, is safe and effective in overcoming immediate HSRs to platins, taxanes, doxorubicin and rituximab via both intravenous and intraperitoneal routes.

Keywords::

• adverse drug reactions
• anaphylaxis
• carboplatin
• chemotherapy agents
• hypersensitivity reactions
• paclitaxel
• rapid desensitization

Acknowledgements

T Limsuwan would like to acknowledge Professor S Janwityanujit, Division of Allergy Immunology and Rheumatology, Ramathibodi Hospital, Bangkok, Thailand, for her help in manuscript preparation and critique of this review, all the nurses in the MICU at BWH and in the outpatient clinic at Dana Farber Cancer Institute, who have been dedicating their efforts in caring for the patients. We are indebted to all our patients, and appreciate their courage and willingness to undergo desensitization.

Notes

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