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Cancer Chemotherapy and Pharmacology

, Volume 82, Issue 5, pp 777–785 | Cite as

A new non-dilution rapid desensitization protocol successfully applied to all-grade platinum hypersensitivity

  • Soo Jie Chung
  • Sung-Yoon Kang
  • Rae-Young Kang
  • Young-Chan Kim
  • Kyung-Hun Lee
  • Tae-Yong Kim
  • Sae-Won Han
  • Hye-Ryun Kang
Original Article
  • 222 Downloads

Abstract

Purpose

Desensitization is a safe alternative for patients with hypersensitivity reactions (HSRs) to platinum-based chemotherapeutic agents and widely used in real practice by employing stepwise administration of multiple serial dilutions of the culprit drugs. However, its labor-intensive nature has required a simpler protocol that is easier to prepare and perform.

Methods

We performed an observational study of patients with platinum HSR who underwent a new non-dilution one-bag desensitization protocol. Premedication consisted of Montelukast as well as H1 and H2 blockers. The outcomes and safety profiles of a new protocol were assessed.

Results

A total of 36 patients were recruited (oxaliplatin 23, carboplatin 9, and cisplatin 4) and the most common grade of HSR presented was grade 2 (61.1%), followed by grade 3 (25%), and grade 1 (13.9%). Of 175 desensitization procedures, all cases were successfully completed in re-administration of culprit chemotherapeutic platinum agents; 146 (83.4%) had no breakthrough reactions (BTRs) while 29 (16.6%) did. Most BTRs were mild reactions (grade 1, 51.7%) or moderate reactions (grade 2, 44.8%) of Brown’s Scale. Although there was one case of asymptomatic mild hypotension (grade 3, 3.5%), categorized as severe reaction, dyspnea, desaturation, and anaphylaxis did not occur. The proportion of severe HSRs was significantly lower than that of initial HSRs (3.5% vs. 25%, P = 0.0167).

Conclusions

The new non-dilution desensitization protocol was safe and effective for re-administration of culprit platinum agents in patients with a history of HSRs. Therefore, this new protocol can be used as an alternative to existing protocols using multiple serial dilutions.

Keywords

Drug hypersensitivity Antineoplastic agents Desensitization Immunologic Platinum Drug-related side effects and adverse reactions 

Abbreviations

AUC

Area under the curve

BTR

Breakthrough reaction

HSR

Hypersensitivity reaction

Notes

Acknowledgements

This research was supported by a Grant from Ministry of Food and Drug Safety to the regional pharmacovigilance center in 2017.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

280_2018_3662_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Institute of Allergy and Clinical ImmunologySeoul National University Medical Research CenterSeoulSouth Korea
  3. 3.Department of PharmacySeoul National University College of MedicineSeoulSouth Korea
  4. 4.Cancer Research InstituteSeoul National University College of MedicineSeoulSouth Korea
  5. 5.Drug Safety Monitoring CenterSeoul National University HospitalSeoulSouth Korea

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