Risk-stratification protocol for carboplatin and oxaliplatin hypersensitivity: repeat skin testing to identify drug allergy.

Abstract

BACKGROUND:

Hypersensitivity reactions (HSRs) to platinum-based chemotherapies are increasingly being recognized. The authors developed a novel risk-stratification protocol that was used successfully in a small number of patients with carboplatin-induced HSRs.

OBJECTIVE:

To describe the utility of this protocol in a large number of patients with carboplatin- or oxaliplatin-induced HSRs.

METHODS:

A 5-year retrospective review of patients referred to Massachusetts General Hospital with carboplatin- or oxaliplatin-induced HSR was performed. Patients were managed using a risk-stratification protocol using 3 repeat skin tests (STs) with intervening desensitizations. If the repeat ST result remained negative 3 times, patients received subsequent infusions without desensitization.

RESULTS:

From 2008 to 2012, 142 patients (92 treated with carboplatin, 50 treated with oxaliplatin) completed 574 desensitizations. Most patients were women (84.5%, mean ± SD 58.1 ± 9.3 years). Patients with carboplatin-induced HSRs were classified as having positive (n = 32, 34.8%), negative (n = 38, 41.3%), or converted (n = 22, 23.9%) ST reactions when the initial negative ST reaction converted to positive at repeat ST. Of those with oxaliplatin-induced HSRs, 22 (44%) had positive, 25 (50%) had negative, and 3 (6%) had converted ST reactions. Of the patients with negative ST reactions, 17 with carboplatin-induced HSRs and 16 with oxaliplatin-induced HSRs safely completed 59 and 95 outpatient infusions, respectively, without desensitizations. For carboplatin and oxaliplatin, ST conversion was associated with an interval of at least 6 months from the HSR to the initial ST (carboplatin, P = .002; oxaliplatin, P = .045).

CONCLUSION:

This risk-stratification protocol for presumed carboplatin- and oxaliplatin-induced HSRs safely identifies false-negative ST reactions and nonallergic patients who can receive infusions without desensitizations. This leads to fewer unnecessary desensitizations and improved patient care.

• Authors: Alberta L Wang, Sarita U Patil, Aidan A Long, Aleena Banerji
• Journal: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 115 Issue 5 Pg. 422-8 (Nov 2015) ISSN: 1534-4436 [Electronic] United States
• PMID: 26298407 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Organoplatinum Compounds
• Oxaliplatin
• Carboplatin

Topics

• Carboplatin (immunology)
• Desensitization, Immunologic (methods)
• Drug Hypersensitivity (immunology)
• False Negative Reactions
• Female
• Humans
• Male
• Massachusetts
• Middle Aged
• Organoplatinum Compounds (immunology)
• Oxaliplatin
• Retrospective Studies
• Risk
• Skin Tests (methods)