A large single hospital experience using drug provocation testing and rapid drug desensitization in hypersensitivity to antineoplastic and biological agents

Publication date: Available online 8 August 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Ricardo Madrigal-Burgaleta, Lorena Bernal-Rubio, Maria Pilar Berges-Gimeno, Laura Victoria Carpio-Escalona, Patricia Gehlhaar, Emilio Alvarez-Cuesta

ABSTRACT

Background

Large-scale studies of Drug Provocation Testing (DPT) or Rapid Drug Desensitization (RDD) for hypersensitivity to antineoplastics and biologicals are scarce and limited to a few institutions

Objective

Our aim was to review our experience with DPT and RDD in a large number of patients with a history of hypersensitivity to antineoplastics and biologicals and summarize the practical implications of that experience.

Methods

7-year prospective, observational, longitudinal study with reactive patients referred to the Desensitization Program at Ramon y Cajal University Hospital (RCUH). Patients were selected after following our systematic and validated diagnostic approach (clinical history, ST, risk-assessment, specific-IgE, DPT) prior to RDD. Candidate patients underwent RDD using the RCUH-protocol. Cetuximab reactors underwent one-bag RDDs.

Results

1,027 intravenous RDDs were performed using the RCUH-protocol (399 platins, 395 taxanes, 178 biologicals, 55 other drugs), and 1,026 were successfully accomplished in the 186 patients (of 515 referred patients) who met inclusion criteria for RDD. No breakthrough-reactions occurred in 88% of RDDs. Most breakthrough-reactions were mild. 341 DPTs were performed, and 229 were negative (67%). DPTs helped exclude hypersensitivity in 44% of referred-patients (229/515). Additionally, 77 one-bag RDDs were performed in 6 cetuximab-reactive patients.

Conclusions

This experience allows us to describe general management plans, as well as specific patient phenotypic patterns, predictors for reactions and risk considerations which need a tailored approach (taking into account the three prominent drug categories: platins, taxanes and biologicals).