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. 2024 Mar;16(2):142-153.
doi: 10.4168/aair.2024.16.2.142.

Hypersensitivity Reactions to Taxanes: A Multicenter Study for Outcomes and Safety of Rapid Drug Desensitization

Makbule Seda Bayrak Durmaz  1 , Done Gulcin Unutmaz  1 , Meryem Demir  2 , Ozlem Goksel  2 , Adile Berna Dursun  3   4 , Sevim Bavbek  5
Affiliations

Hypersensitivity Reactions to Taxanes: A Multicenter Study for Outcomes and Safety of Rapid Drug Desensitization

Makbule Seda Bayrak Durmaz et al. Allergy Asthma Immunol Res. 2024 Mar.

Abstract

Purpose: Taxanes can cause hypersensitivity reactions (HSRs), which pose a significant challenge in the treatment of malignancies. Patients who are eligible for rapid drug desensitization (RDD) can continue treatment; however, some patients experience breakthrough reactions (BTRs). Data about risk factors for BTRs during RDDs in patients with HSRs to taxanes are limited.

Methods: This was a multicenter, retrospective study of patients with immediate-HSRs to taxanes. Initial HSRs were classified as grade 1, 2, or 3 based on severity. Prick/intradermal skin tests were performed with implicated taxanes. A 12-step protocol was used during RDD.

Results: The study comprised 75 patients (F/M: 63/12, mean age 49.92 ± 11.72 years, 43 HSRs to paclitaxel, 32 HSRs to docetaxel). The majority of reactions (86.7%) occurred during the first or second exposure. The prevalence of drug allergy history was higher in patients with paclitaxel HSR than in those with docetaxel HSR, although it was not statistically significant (23.3% vs. 6.3%). The initial HSRs were mostly grade 2 (n = 50, 66.7%) or grade 3 (n = 22, 29.3%). Skin tests with implicated taxanes were done on 48 patients, and the rate of positive response in patients with grade 1, 2, and 3 initial HSRs were 50%, 17.6%, and 16.7%, respectively. . A total of 255 RDDs were completely performed, although BTRs occurred in 27 (grade 1, 55.6%; grade 2, 40.7%; grade 3, 3.7%). There were no statistically significant correlations between the risk of BTR and age, drug cycle, gender, positivity of skin test or atopy. The step reduction was successfully done on 9 eligible patients with mild or moderate HSRs during the 12-step RDDs.

Conclusions: Our experience demonstrates a 100% success rate in completing the 255 RDDs for taxanes, affirming the safety and efficacy of the RDD within the study population.

Keywords: Desensitization; chemotherapy; docetaxel; drug hypersensitivity; neoplasms; paclitaxel; safety; taxoids.

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Conflict of interest statement

There are no financial or other issues that might lead to conflict of interest.

Figures

Fig. 1
Fig. 1. The flow diagram of the study.
HSR, hypersensitivity reaction; RDD, rapid drug desensitization; BTR, breakthrough reaction.
Fig. 2
Fig. 2. Symptoms and signs during initial hypersensitivity reactions in 75 patients.
Fig. 3
Fig. 3. (A) Percentage of patients who tolerated RDD without BTR or had one or more than one BTR during RDD. (B) percentage of patients who had mild or no reactions and severe reactions (grade 2 and 3) during BTR. (C) Desensitization number of which breakthrough hypersensitivity reactions occurred.
RDD, rapid drug desensitization; BTR, breakthrough reaction.
See this image and copyright information in PMC

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