Immunoallergology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria Hospital, Lisboa, Portugal.
Immunoallergology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria Hospital, Lisboa, Portugal.
Ann Allergy Asthma Immunol. 2020 Sep;125(3):325-333.e1. doi: 10.1016/j.anai.2020.04.017. Epub 2020 Apr 27.
Hypersensitivity reactions to antineoplastic agents may lead to discontinuation of first-line treatments. Rapid drug desensitization (RDD) allows for a safe reintroduction in patients who are allergic to them.
To evaluate the safety and efficacy of the Brigham and Women's Hospital's 12-step RDD in a Portuguese patient population with cancer and to identify markers associated with breakthrough reactions (BTRs) to platins.
We conducted a retrospective review of desensitizations undertaken at the Immunoallergology Day-Care Unit of the Santa Maria Hospital in Lisbon, Portugal, from July 2008 to July 2019. Adult patients with cancer and with immediate hypersensitivity reactions were included. Skin testing was performed to platins, trastuzumab, and cetuximab. The 12-step protocol was used for most patients, and a shorter protocol was used in 9 patients who were taxane-reactive to resume regular infusions.
A total of 1471 RDDs were performed in 272 patients to 136 platins, 124 taxanes, 13 monoclonal antibodies, and 10 other drugs. Skin test results were positive in 127 of patients who were platin-reactive (95.3%) and negative in patients who were cetuximab- and trastuzumab-reactive. There were 141 BTRs during RDD (9.6% of infusions), 79.4% induced by platins with the majority having mild reactions (68.8%). There were 8 patients who were paclitaxel-reactive, and who completed a shorter protocol and resumed regular infusions successfully. Multiple platin infusions (cutoff: ≥10) and total immunoglobulin E greater than or equal to 100 U/mL were identified as independent risk factors for BTRs in patients who were platin-reactive.
This large single-center study confirmed the safety and efficacy of the 12-step RDD protocol in a diverse cancer population, providing evidence of its universal applications. Total immunoglobulin E is a potentially useful biomarker to identify high-risk patients who are platin-reactive.
抗肿瘤药物的过敏反应可能导致一线治疗的中断。快速药物脱敏（RDD）可使对药物过敏的患者安全重新使用。
评估布列根妇女医院的 12 步 RDD 在葡萄牙癌症患者人群中的安全性和疗效，并确定与铂类药物突破性反应（BTR）相关的标志物。
我们对 2008 年 7 月至 2019 年 7 月在葡萄牙里斯本圣玛丽亚医院免疫过敏日间护理单位进行的脱敏治疗进行了回顾性研究。纳入患有癌症且有即刻过敏反应的成年患者。对铂类、曲妥珠单抗和西妥昔单抗进行皮肤试验。大多数患者采用 12 步方案，9 例紫杉醇反应性患者采用较短方案恢复常规输注。
共对 272 例患者的 136 例铂类药物、124 例紫杉烷类药物、13 种单克隆抗体和 10 种其他药物进行了 1471 次 RDD。对 127 例铂类药物反应性患者的皮肤试验结果为阳性（95.3%），对曲妥珠单抗和西妥昔单抗反应性患者的皮肤试验结果为阴性。在 RDD 期间发生了 141 例 BTR（输注的 9.6%），79.4%由铂类药物引起，大多数为轻度反应（68.8%）。有 8 例紫杉醇反应性患者，他们完成了较短的方案并成功恢复常规输注。在铂类药物反应性患者中，多次铂类药物输注（临界值：≥10）和总免疫球蛋白 E 大于或等于 100 U/mL 被确定为 BTR 的独立危险因素。
这项大型单中心研究证实了 12 步 RDD 方案在不同癌症人群中的安全性和疗效，为其广泛应用提供了证据。总免疫球蛋白 E 可能是识别铂类药物反应性高危患者的有用生物标志物。
