Role of skin tests in the diagnosis of immediate hypersensitivity reactions to taxanes. Results of a multicenter study

Publication date: Available online 5 October 2018

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

Author(s): Mauro Pagani, Sevim Bavbek, Adile Berna Dursun, Patrizia Bonadonna, Maria Caralli, Josefina Cernadas, Gabriele Cortellini, Maria Teresa Costantino, Asli Gelincik, Giuseppe Lucchini, Mariana Castells

Abstract

Background

Immediate hypersensitivity reactions (HSRs) to taxanes have been increasing in recent years, but the importance of skin tests in allergological work-up has not been established.

Objective

In our study we tried to evaluate the role of prick and intradermal tests in the diagnosis of HSRs to paclitaxel and docetaxel.

Methods

In this multicenter prospective study we enrolled patients with immediate HSRs reactions to the aforesaid agents. Skin tests were performed on these subjects and, if results were negative, intradermal tests with the culprit drug were conducted. Patients with grade 1 reactions subsequently underwent graded challenge; in cases of grade 2-3 reactions and/or positive tests the culprit drug was administered with a desensitization schedule. Skin tests were also performed in 30 control subjects exposed to the taxanes without HSRs.

Results

84 patients, 63 with HSRs to paclitaxel and 21 to docetaxel were recruited in the period July 2015 - July 2017 by 8 centers. 58 patients (69%) developed grade 2-3 reactions. Prick test resulted negatives in all the cases, while intradermal tests were positive in 14 patients, 10 with paclitaxel (15.9 %) and 4 with docetaxel (19%). The positivity of skin tests significantly correlated with grade 3 reactions and cutaneous involvement during HSRs. Graded challenge was performed in 16 patients without problems and 58 subjects underwent desensitization, which was well tolerated in all but two cases. In the control group skin testing resulted negatives in all the patients.

Conclusions

Skin tests for taxanes seem useful and can be performed in the allergological work-up of subjects with HSRs to these agents, especially in cases of severe reactions with cutaneous involvement.