A new non-dilution rapid desensitization protocol successfully applied to all-grade platinum hypersensitivity

• Published in: Cancer chemotherapy and pharmacology 2018-11, Vol.82 (5), p.777-785
• Main Authors: Chung, Soo Jie, Kang, Sung-Yoon, Kang, Rae-Young, Kim, Young-Chan, Lee, Kyung-Hun, Kim, Tae-Yong, Han, Sae-Won, Kang, Hye-Ryun
• Format: Article
• Language: English
• Subjects: Anaphylaxis; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Cancer Research; Carboplatin; Carboplatin - administration & dosage; Carboplatin - adverse effects; Chemotherapy; Cisplatin; Cisplatin - administration & dosage; Cisplatin - adverse effects; Desaturation; Desensitization; Desensitization, Immunologic - methods; Dilution; Drug Administration Schedule; Drug Hypersensitivity - prevention & control; Drug-Related Side Effects and Adverse Reactions - prevention & control; Dyspnea; Female; Humans; Hypersensitivity; Hypotension; Infusions, Intravenous; Male; Medicine; Medicine & Public Health; Middle Aged; Montelukast; Oncology; Original Article; Oxaliplatin; Oxaliplatin - administration & dosage; Oxaliplatin - adverse effects; Patients; Pharmacology/Toxicology; Platinum; Respiration; Retrospective Studies; Severity of Illness Index; Skin Tests
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-018-3662-0

Purpose Desensitization is a safe alternative for patients with hypersensitivity reactions (HSRs) to platinum-based chemotherapeutic agents and widely used in real practice by employing stepwise administration of multiple serial dilutions of the culprit drugs. However, its labor-intensive nature has required a simpler protocol that is easier to prepare and perform. Methods We performed an observational study of patients with platinum HSR who underwent a new non-dilution one-bag desensitization protocol. Premedication consisted of Montelukast as well as H1 and H2 blockers. The outcomes and safety profiles of a new protocol were assessed. Results A total of 36 patients were recruited (oxaliplatin 23, carboplatin 9, and cisplatin 4) and the most common grade of HSR presented was grade 2 (61.1%), followed by grade 3 (25%), and grade 1 (13.9%). Of 175 desensitization procedures, all cases were successfully completed in re-administration of culprit chemotherapeutic platinum agents; 146 (83.4%) had no breakthrough reactions (BTRs) while 29 (16.6%) did. Most BTRs were mild reactions (grade 1, 51.7%) or moderate reactions (grade 2, 44.8%) of Brown’s Scale. Although there was one case of asymptomatic mild hypotension (grade 3, 3.5%), categorized as severe reaction, dyspnea, desaturation, and anaphylaxis did not occur. The proportion of severe HSRs was significantly lower than that of initial HSRs (3.5% vs. 25%, P  = 0.0167). Conclusions The new non-dilution desensitization protocol was safe and effective for re-administration of culprit platinum agents in patients with a history of HSRs. Therefore, this new protocol can be used as an alternative to existing protocols using multiple serial dilutions.