Allergic reactions to chemo

[john]

Hypersentitivity reactions can be handled using rapid desensitization for many cancer treatments (besides chemo)

Background: The purpose of the study was to investigate the safety and efficacy of a rapid desensitization protocol used in the inpatient and outpatient settings for patients with hypersensitivity reactions (HR) to carboplatin or paclitaxel. Methods: The 3-solution, 12-step protocol combined gradual increases in the rate of infusion and concentration of the chemotherapy, infusing the target dose over 5.8 hours for inpatient and 3.8 hours for outpatient administration. Patients were premedicated with antihistamines without additional corticosteroids. Results: Between February 2000 and December 2004, 45 patients with history of ovarian (n=39), fallopian (n=3), endometrial (n=2), and peritoneal (n=1) cancer who had moderate to severe HR to either carboplatin or paclitaxel were evaluated. The 26 patients who reacted to carboplatin received a median of 8 courses before developing their initial HR while 16 of 19 patients with HR to paclitaxel reacted on their first exposure to the agent. 17 of 22 patients with HR to carboplatin had positive skin tests. All 45 patients successfully completed 195 planned courses of desensitization (88 courses of carboplatin and 107 of paclitaxel). After undergoing successful inpatient desensitization, 6 patients thus far have received 22 desensitizations in the outpatient setting without adverse reactions. Of 26 patients receiving carboplatin desensitization for recurrent cancer, 10 had a radiographic response (partial or complete response) and/or >50% drop of initial CA125 value, 11 had stable disease radiographically and/or CA125 response (<50% drop), 1 is still unevaluable for response, and 4 had progressive disease after 2 cycles of carboplatin. Conclusions: The rapid desensitization protocol has proven to be safe and effective in the inpatient and outpatient settings for patients with HR to either carboplatin or paclitaxel. This protocol has allowed appropriate patients to continue chemotherapy in the setting of moderate to severe HR, and the study warrants the incorporation of the protocol into standard clinical practice.