Mauro Pagani1, Sevim Bavbek2, Adile Berna Dursun3, Patrizia Bonadonna4, Maria Caralli5, Josefina Cernadas6, Gabriele Cortellini7, Maria Teresa Costantino8, Asli Gelincik9, Giuseppe Lucchini10, Mariana Castells11. 1. Medicine Ward, Medical Department ASST of Mantova, Mantua, Italy. Electronic address: mauro.pagani@asst-mantova.it. 2. Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey. 3. Recep Tayyip Erdogan Universitesi, Department of Chest Disease, Ankara, Turkey. 4. Allergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. 5. Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 6. Allergy Department, University Hospital S.João, Porto, Portugal. 7. Internal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini Hospital, Rimini, Italy. 8. Allergy Unit, Medical Department, ASST of Mantova, Mantua, Italy. 9. Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey. 10. Biostatistical Service ASST of Mantova, Mantua, Italy. 11. Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Abstract
BACKGROUND: Immediate hypersensitivity reactions (HSRs) to taxanes have been increasing in recent years, but the importance of skin tests in allergological workup 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 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 or 3 reactions and/or positive test results, 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: A total of 84 patients (63 with HSRs to paclitaxel and 21 to docetaxel) were recruited in the period July 2015 to July 2017 by 8 centers; 58 patients (69%) developed grade 2 or 3 reactions. Prick test results were negative in all the cases, whereas intradermal test results 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 2 cases. In the control group, skin test results were negative in all the patients. CONCLUSIONS: Skin tests for taxanes seem useful and can be performed in the allergological workup of subjects with HSRs to these agents, especially in cases of severe reactions with cutaneous involvement.
BACKGROUND: Immediate hypersensitivity reactions (HSRs) to taxanes have been increasing in recent years, but the importance of skin tests in allergological workup 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 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 or 3 reactions and/or positive test results, 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: A total of 84 patients (63 with HSRs to paclitaxel and 21 to docetaxel) were recruited in the period July 2015 to July 2017 by 8 centers; 58 patients (69%) developed grade 2 or 3 reactions. Prick test results were negative in all the cases, whereas intradermal test results 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 2 cases. In the control group, skin test results were negative in all the patients. CONCLUSIONS: Skin tests for taxanes seem useful and can be performed in the allergological workup of subjects with HSRs to these agents, especially in cases of severe reactions with cutaneous involvement.
Authors: José Ferreira Pires-Júnior; Tânia Couto Machado Chianca; Eline Lima Borges; Cissa Azevedo; Giovana Paula Rezende Simino Journal: Rev Lat Am Enfermagem Date: 2021-11-08
Authors: Lucila De Campos; Pedro Giavina-Bianchi; Shree Acharya; Donna-Marie Lynch; Jorge Kalil; Mariana C Castells Journal: Front Allergy Date: 2022-07-13