Diagnostic and predictive value of skin testing in platinum salt hypersensitivity.

Abstract

BACKGROUND:

Hypersensitivity reactions to platinum salts are potentially lethal adverse events in chemotherapy, and often require its discontinuation. Several preventive procedures have been proposed: premedication, desensitization regimens, or replacement with a different platinum salt.

OBJECTIVE:

We therefore assessed the value of skin tests with platinum salts. A positive result would confirm their responsibility in hypersensitivity reaction, whereas a negative result would identify candidates for continuation of therapy using a different platinum salt.

METHODS:

Patch tests, prick tests, and intradermal tests with cisplatin, carboplatin, and oxaliplatin were performed in 21 patients.

RESULTS:

Skin tests were positive in 14 of 21 cases. Prick tests were positive in 5 cases with the suspected platinum salt. Intradermal tests were positive in 12 of 19 cases, always when the hypersensitivity occurred less than 2 hours after infusion. Cross-reactions were observed in 4 cases. Delayed readings of skin tests at 24 hours and 48 hours were positive in 3 patients. Patch tests were negative in all the 21 patients tested. Replacement with another platinum salt was performed in 13 patients using one that gave a negative skin test. A relapse of symptoms occurred in 1 patient.

CONCLUSION:

Intradermal tests are particularly indicated for the diagnosis of immediate hypersensitivity reaction. Their good negative predictive value allows safe retreatment by detecting a potential cross-reaction.

CLINICAL IMPLICATIONS:

The frequency of cross-reactions among cisplatin, carboplatin, and oxaliplatin has not been clearly established. Skin tests allow different platinum salts to be given and avoid discontinuation of chemotherapy.

• Authors: Vanessa Leguy-Seguin, Genevieve Jolimoy, Bruno Coudert, Corine Pernot, Sophie Dalac, Pierre Vabres, Evelyne Collet
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 119 Issue 3 Pg. 726-30 (Mar 2007) ISSN: 0091-6749 [Print] United States
• PMID: 17258305 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Antineoplastic Agents
• Organoplatinum Compounds
• Salts
• Oxaliplatin
• Platinum
• Carboplatin
• Cisplatin

Topics

• Adult
• Aged
• Antineoplastic Agents (immunology)
• Carboplatin (immunology)
• Cisplatin (immunology)
• Cross Reactions
• Drug Hypersensitivity (diagnosis)
• Female
• Humans
• Male
• Middle Aged
• Organoplatinum Compounds (immunology)
• Oxaliplatin
• Platinum (immunology)
• Prognosis
• Prospective Studies
• Salts (immunology)
• Skin Tests