University Children's Medical Institute, National University Hospital, Singapore, Singapore Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Allergy, Arthritis & Rheumatism Clinic, Gleneagles Medical Centre, Singapore, Singapore.
Postgrad Med J. 2015 Mar;91(1073):145-50. doi: 10.1136/postgradmedj-2014-132686. Epub 2015 Feb 6.
Hypersensitivity reactions to chemotherapy drugs pose significant difficulties in management, especially when no suitable alternative is available or acceptable and delay in continuation of treatment may be life-threatening. Such reactions may be IgE- or non-IgE-mediated and have varied manifestations. Timely recognition and treatment of life-threatening hypersensitivity reactions are essential. Identification of patients at high risk of developing hypersensitivity reactions allows risk stratification to guide clinical decision-making. Skin testing for carboplatin hypersensitivity has good predictive value but is not yet established for oxaliplatin and taxane hypersensitivity. Rapid desensitisation may be considered if no suitable alternative drug is available. Available protocols have shown good safety and efficacy but must be performed in an appropriate setting with adequate monitoring. There are many avenues for research into the utility of skin testing for other chemotherapy agents as well as in vitro tests.
化疗药物过敏反应的管理存在重大困难，尤其是在没有合适替代药物或无法接受替代药物，且延迟治疗可能危及生命的情况下。此类过敏反应可能由 IgE 介导或非 IgE 介导，且具有不同的表现。及时识别和治疗危及生命的过敏反应至关重要。确定发生过敏反应风险较高的患者有助于进行风险分层，以指导临床决策。卡铂过敏皮肤试验具有良好的预测价值，但尚未确立用于奥沙利铂和紫杉烷类药物过敏的皮肤试验。如果没有合适的替代药物，可考虑快速脱敏。现有的方案已显示出良好的安全性和疗效，但必须在适当的环境中进行，并进行充分的监测。对于其他化疗药物的皮肤试验以及体外试验的实用性，有许多研究途径。
