Hypersensitivity and desensitization to antineoplastic agents: outcomes of 189 procedures with a new short protocol and novel diagnostic tools assessment

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Abstract
Background: Desensitization to antineoplastic agents is becoming a standard of care. Efforts to establish and improve these techniques are being made at many institutions. Our aims are to evaluate a new rapid desensitization protocol designed to be shorter (approximately 4 h) and safer (reducing hazardous drugs exposure risks) and to assess the oxaliplatin‐specific immunoglobulinE(IgE) as a novel diagnostic tool.Methods: Prospective, observational, longitudinal study with patients who, for a 1‐year period, suffered reactions to antineoplastic agents and were referred to theDesensitizationProgram atRamon yCajalUniversityHospital (RCUH). Patients were included or excluded as desensitization candidates after anamnesis, skin testing, risk assessment, and graded challenge. SpecificIgEwas determined in oxaliplatin‐reactive patients. Candidate patients were desensitized using the newRCUHrapid desensitization protocol.Results: Of 189 intravenous rapid desensitizations, 188 were successfully accomplished in the 23 patients who met inclusion criteria for desensitization (of 58 referred patients). No breakthrough reactions occurred in 94% of desensitizations, and most breakthrough reactions were mild. In 10 oxaliplatin‐reactive patients, 38 desensitizations were successfully accomplished. Sensitivity for oxaliplatin‐specificIgEwas 38% (0.35UI/l cutoff point) and 54% (0.10UI/l cutoff point); specificity was 100% for both cutoff points.Conclusions: In the hands of aDesensitizationProgram, managed by drug desensitization experts, this new protocol has proven an effective therapeutic tool for hypersensitivity to several antineoplastic agents (oxaliplatin, carboplatin, paclitaxel, docetaxel, cyclophosphamide, and rituximab); moreover, it improves safety handling of hazardous drugs. We report the first large series of oxaliplatin desensitizations.Oxaliplatin‐specificIgEdetermination could be helpful.

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