Rapid desensitization for hypersensitivity reactions to chemotherapy agents.

PURPOSE OF REVIEW: Hypersensitivity reactions (HSRs) to chemotherapy agents have limited their use for fear of inducing severe reactions or death. Alternative regimens may be limited by tumor sensitivity and the need to provide first-line therapy. Rapid desensitizations allow patients to be treated with medications to which they have presented a HSR. The purpose of this review is to highlight the indications and recent developments in chemotherapy rapid desensitization protocols. RECENT
FINDINGS: Intravenous and oral rapid desensitization protocols are available for taxenes, platinums, doxorubicin, monoclonal antibodies and others. Candidate patients present mild to severe type I hypersensitivity, mast cell/IgE-dependent reactions, as seen with platinums. Anaphylactoid reactions, such as those with taxenes, can be treated with the same protocols. Repeat desensitizations in outpatient settings are well tolerated and allow patients to remain in clinical studies/trials. Breakthrough symptoms during desensitizations are less severe than the initial reaction and no deaths have been reported. Cancer remissions are similar to those for nondesensitized patients.
SUMMARY: The use of rapid desensitization protocols for cancer patients with HSRs to chemotherapy depends on their demonstrated tolerability and efficacy in selected populations. Education of nurses, pharmacists, and oncology and allergy specialists is needed to improve their universal application as standard of care.