Anaphylactic and anaphylactoid reactions to chemotherapy: outcomes and safety of rapid intravenous and intraperitoneal desensitizations in 413 cases

Abstract

5526 Background: Hypersensitivity reactions to chemotherapeutic drugs, including monoclonal antibodies, often require that the provoking medication be discontinued, thus raising a dilemma for the caregiver: further use could precipitate a severe, even fatal, allergic reaction upon re-exposure, but alternative drugs may be poorly tolerated or much less effective compared to the preferred agent. To address this difficulty, we have developed a standardized rapid desensitization protocol for achieving temporary tolerization to drug allergens. In this study, we evaluate the safety and efficacy of this protocol. Methods: Ninety-eight patients who developed hypersensitivity reactions in response to treatment with carboplatin, cisplatin, oxaliplatin, paclitaxel, pegylated doxorubicin, adriamycin, or rituximab received rapid desensitization to these agents. A standardized 12-step protocol was used, with treatment applied intravenously or intraperitoneally. Initial desensitizations occurred in the Medical Intensive Care Unit, while most subsequent infusions took place in an outpatient setting. Safety and efficacy of the protocol were assessed by review of treatment records. Results: Of the 413 desensitizations performed, 94% induced mild or no reactions. No life-threatening HSRs or deaths occurred during the procedure, and all patients received their full target dose. Most reactions occurred during the first desensitization. Reactions were most commonly reported at the last step of the protocol. Desensitization infusions via the intravenous and intraperitoneal routes were equally effective. Conclusions: Our standardized 12-step protocol for rapid drug desensitization is safe and effective and should be the standard of care in treating patients who develop hypersensitivity reactions to chemotherapeutic drugs, including monoclonal antibodies. No significant financial relationships to disclose.