Department of Oncology and Hematology, Cantonal Hospital, St Gallen, Switzerland.
Ann Oncol. 2012 Sep;23 Suppl 10:x313-9. doi: 10.1093/annonc/mds314.
Drug hypersensitivity reactions (HSR) are adverse events resembling allergy which occur at therapeutic doses. Both anticancer chemotherapeutics and monoclonal antibodies have the potential for acute HSR. all infusion reactions involve the immune system; however, some (anaphylactic) are allergic in nature and usually are mediated by immunoglobulin E (IgE), whereas others (anaphylactoid) are not true allergic reactions and are not mediated by IgE. although HSR can be allergic or nonallergic, the clinical manifestations are the same and require prompt, accurate assessment and management to avoid severe adverse events, including fatality. Monoclonal antibodies have a unique side-effect profile that includes the potential for nonallergic HSR caused by cytokine release. Chemotherapeutic agents with the highest potential for acute HSR include the platinum salts, taxanes, procarbazine, asparaginase and the epipodophyllotoxins. From all anticancer agents, rituximab causes the majority of HSR (27%), followed by paclitaxel (10%). The most frequent symptoms in patients experiencing acute HSR include chest pain, dyspnea, wheezing and exanthema for the taxanes, dyspnea and exanthema for platinum salts, chills and rigor for antibodies. Patients with mild-to-moderate acute HSR can be rechallenged following intensified prophylaxis, but rechallenge is usually not recommended following severe HSR.
药物超敏反应（HSR）是在治疗剂量下发生的类似过敏的不良反应。抗癌化疗药物和单克隆抗体都有可能引起急性 HSR。所有输液反应都涉及免疫系统；然而，有些（过敏样）是过敏性质的，通常由免疫球蛋白 E（IgE）介导，而其他（过敏样）不是真正的过敏反应，不由 IgE 介导。虽然 HSR 可以是过敏或非过敏的，但临床表现相同，需要及时、准确的评估和管理，以避免严重的不良事件，包括死亡。单克隆抗体具有独特的副作用谱，包括由细胞因子释放引起的非过敏 HSR 的可能性。具有急性 HSR 最大潜在风险的化疗药物包括铂盐、紫杉烷类、丙卡巴肼、门冬酰胺酶和表鬼臼毒素。在所有抗癌药物中，利妥昔单抗引起的 HSR 最多（27%），其次是紫杉醇（10%）。在经历急性 HSR 的患者中，最常见的症状包括紫杉烷类的胸痛、呼吸困难、喘息和皮疹，铂盐类的呼吸困难和皮疹，抗体类的寒战和肌强直。轻度至中度急性 HSR 患者可以在强化预防措施后再次接受挑战，但严重 HSR 后通常不建议再次挑战。
