UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, San Francisco, CA, USA.
Brigham and Women's Hospital, Department of Medicine, Division of Allergy and Clinical Immunology, Boston, MA, USA.
Clin Rev Allergy Immunol. 2022 Jun;62(3):432-448. doi: 10.1007/s12016-021-08877-y. Epub 2021 Aug 2.
Hypersensitivity reactions (HSRs) to chemotherapy agents can present a serious challenge to treating patients with preferred or first-line therapies. Allergic reactions through an immunologic mechanism have been established for platinum and taxane agents, which are used to treat a wide variety of cancers including gynecologic cancers. Platin HSRs typically occur after multiple cycles of chemotherapy, reflecting the development of drug IgE sensitization, while taxane HSRs often occur on first or second exposure. Despite observed differences between platin and taxane HSRs, drug desensitization has been an effective method to reintroduce both chemotherapeutic agents safely. Skin testing is the primary diagnostic tool used to risk-stratify patients after initial HSRs, with more widespread use for platinum agents than taxanes. Different practices exist around the use of skin testing, drug challenge, and choice of desensitization protocol. Here, we review the epidemiology, mechanism, and clinical presentation of HSRs to platinum and taxane agents, as well as key controversies in their evaluation and management.
化疗药物过敏反应（HSR）对使用首选或一线治疗方案的患者的治疗构成严重挑战。已确定铂类和紫杉烷类药物的过敏反应是通过免疫机制发生的，这些药物用于治疗包括妇科癌症在内的多种癌症。铂类 HSR 通常发生在多次化疗周期后，反映了药物 IgE 致敏的发展，而紫杉烷类 HSR 通常发生在首次或第二次接触时。尽管观察到铂类和紫杉烷类 HSR 之间存在差异，但药物脱敏已成为安全重新引入这两种化疗药物的有效方法。皮肤试验是在初次 HSR 后对患者进行风险分层的主要诊断工具，比紫杉烷类药物更广泛地用于铂类药物。在皮肤试验、药物挑战和脱敏方案的选择方面存在不同的做法。在这里，我们回顾了铂类和紫杉烷类药物过敏反应的流行病学、机制和临床表现，以及在其评估和管理方面的主要争议。
