Department of Medicine, Medicine Ward C. Poma Mantova Hospital, ASST Mantova, Mantova, Italy.
Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey.
Allergy. 2022 Feb;77(2):388-403. doi: 10.1111/all.15113. Epub 2021 Oct 26.
Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work-up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.
化疗药物在癌症治疗中已经广泛应用了约 70 年。新的治疗方法的发展并没有阻碍它们的使用，肿瘤学家仍然常规地单独或与其他抗肿瘤药物联合使用它们。然而，所有的化疗药物都可以诱导超敏反应（HSR），其发生率取决于致病药物的不同。这些反应是美国导致致命药物性过敏反应的第三大原因。在欧洲，也有与化疗相关的死亡报告。特别是，大多数反应是由铂类化合物、紫杉烷类、表鬼臼毒素和门冬酰胺酶引起的。尽管这些反应很常见且很重要，但这些反应的理想诊断、治疗和预防途径仍不清楚，实践仍然存在很大的差异，各个中心之间存在很大的差异。因此，欧洲药物过敏网络和欧洲过敏与临床免疫学学会药物过敏兴趣小组组织了一个工作组，提供关于该领域药物超敏反应的过敏学研究的数据和建议。本立场文件旨在就化疗药物引起的 HSR 调查达成共识，并为治疗这些患者的临床医生（如肿瘤学家、过敏学家和内科医生）提供实用建议。关键部分涵盖了风险因素、发病机制、症状、皮肤试验、体外试验、药物激发试验的适应证和禁忌证以及对化疗药物过敏的肿瘤患者的脱敏治疗。在每个部分的末尾，都对陈述、建议和未满足的需求进行了讨论和提出。
