Lee Christina, Gianos Mary, Klaustermeyer William B
Department of Medicine, Division of Allergy and Immunology, VA Greater Los Angeles Healthcare System/University of California Los Angeles, Los Angeles, California 90073, USA.
Ann Allergy Asthma Immunol. 2009 Mar;102(3):179-87; quiz 187-9, 222. doi: 10.1016/S1081-1206(10)60078-6.
To review clinical hypersensitivity reactions related to common cancer chemotherapy agents and to discuss potential management strategies.
PubMed searches were performed for articles published from 1970 to 2008 regarding hypersensitivity to cancer chemotherapy and related agents using the keywords hypersensitivity, allergy, chemotherapy, platinums, taxanes, asparaginase, epipodophyllotoxins, and procarbazine. Retrieved articles were surveyed for additional citations.
Articles were reviewed for relevance to the subject matter, and the most pertinent articles were included in this review.
Hypersensitivity reactions are commonly associated with the use of certain cancer chemotherapy drugs, including platinums, taxanes, asparaginase, procarbazine, and epipodophyllotoxins. Platinum agents (cisplatin, carboplatin, oxaliplatin) are associated with IgE-mediated hypersensitivity reactions, and skin testing may be indicated. Taxane (paclitaxel, docetaxel)-related reactions are generally non-IgE mediated, and premedication with corticosteroids and antihistamines is usually effective. Asparaginase has a high rate of hypersensitivity reactions that are likely IgE mediated or related to complement activation. Skin testing has been recommended but has not been validated for asparaginase. Procarbazine reactions can be IgE mediated but are also associated with a type III reaction manifested by pulmonary toxicity and cutaneous reactions. Hypersensitivity reactions related to epipodophyllotoxins may involve both immunologic and nonimmunologic factors that may be avoided with a slow infusion and premedication.
With the increasing use of cancer chemotherapy agents, hypersensitivity reactions are commonly encountered. Knowledge of the presentations of these reactions and management options give the treating physician the means to make an informed decision of how best to proceed.
回顾与常见癌症化疗药物相关的临床过敏反应，并探讨潜在的处理策略。
利用关键词“过敏反应”“变态反应”“化疗”“铂类”“紫杉烷类”“天冬酰胺酶”“鬼臼毒素类”和“丙卡巴肼”，在PubMed上检索1970年至2008年发表的关于癌症化疗及相关药物过敏反应的文章。对检索到的文章进行调查以获取更多参考文献。
对文章进行相关性审查，将最相关的文章纳入本综述。
过敏反应常与某些癌症化疗药物的使用相关，包括铂类、紫杉烷类、天冬酰胺酶、丙卡巴肼和鬼臼毒素类。铂类药物（顺铂、卡铂、奥沙利铂）与IgE介导的过敏反应相关，可能需要进行皮肤试验。紫杉烷类（紫杉醇、多西他赛）相关反应一般不是由IgE介导的，使用皮质类固醇和抗组胺药进行预处理通常有效。天冬酰胺酶过敏反应发生率高，可能是由IgE介导或与补体激活有关。推荐进行皮肤试验，但天冬酰胺酶的皮肤试验尚未得到验证。丙卡巴肼反应可能是由IgE介导的，但也与以肺部毒性和皮肤反应为表现的Ⅲ型反应有关。与鬼臼毒素类相关的过敏反应可能涉及免疫和非免疫因素，缓慢输注和预处理可避免这些因素。
随着癌症化疗药物使用的增加，过敏反应很常见。了解这些反应的表现和处理方法，有助于治疗医生做出如何最佳处理的明智决定。
