Blanchet Auriane, Robert Julien, Devys Catherine, Collet Morgane, Sorrieul Jeremy
Pharmacie, Institut de Cancérologie de l'Ouest, Angers, France
Pharmacie, Institut de Cancérologie de l'Ouest, Angers, France.
Eur J Hosp Pharm. 2025 Jul 14. doi: 10.1136/ejhpharm-2024-004387.
Hypersensitivity reactions (HSRs) to chemotherapy agents constitute a real challenge for cancer treatment. Skin tests (STs) can help risk-stratify patients after initial HSRs and identify cross-reactions between chemotherapeutic agents.
This study aimed to assess the value of STs in an integrative cancer centre to address the treatment of patients with suspicion of HSRs to platinum salts (carboplatin, oxaliplatin, cisplatin), and taxanes (paclitaxel, docetaxel).
This single-centre, retrospective study was conducted on data collected from hospital medical records between August 2018 and December 2023. STs (prick tests and intradermal tests) were performed according to the recommendations of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology. The concordance between the allergist's recommendations and the therapeutic strategies implemented in clinical practice following ST results was evaluated.
Among the 105 patients included (76 females, 29 males), the positive ST rate was 61%. In total, 71% of the reactions to platinum salts (n=82) were identified as allergies versus 26% for taxane reactions (n=23). We found a cross-reactivity of 34.5% for platinum salts and 66.7% for taxanes. The allergist's recommendations were carried out in practice for a total of 56 patients (53%). For 47 patients (45%), a clinical reason justified not following the allergist's recommendations and discontinuing treatment.
This study confirms the relevance of STs to help oncologists guide treatment strategies after a presumed allergy. As part of the allergological work-up, STs help prevent unnecessary changes to chemotherapy lines in patients with unproven allergies and facilitate the identification of alternative treatments following HSRs. In practice in our centre, allergists' propositions are carried out as much as possible to guide the re-exposure strategy in patient care.
化疗药物引起的超敏反应（HSR）对癌症治疗构成了真正的挑战。皮肤试验（ST）有助于对初次发生HSR后的患者进行风险分层，并识别化疗药物之间的交叉反应。
本研究旨在评估综合癌症中心中ST对于处理疑似对铂盐（卡铂、奥沙利铂、顺铂）和紫杉烷类（紫杉醇、多西他赛）发生HSR患者的治疗价值。
本单中心回顾性研究收集了2018年8月至2023年12月期间医院病历数据。根据欧洲药物过敏网络和欧洲变态反应与临床免疫学会的建议进行ST（点刺试验和皮内试验）。评估了过敏专科医生的建议与ST结果后临床实践中实施的治疗策略之间的一致性。
纳入的105例患者中（女性76例，男性29例），ST阳性率为61%。总体而言，对铂盐的反应（n = 82）中有71%被确定为过敏，而紫杉烷类反应（n = 23）中这一比例为26%。我们发现铂盐的交叉反应率为34.5%，紫杉烷类为66.7%。过敏专科医生的建议在实际中总共对56例患者（53%）得以实施。对于47例患者（45%），临床原因使得未遵循过敏专科医生的建议并停止治疗。
本研究证实了ST对于帮助肿瘤学家在假定过敏后指导治疗策略的相关性。作为变态反应学检查的一部分，ST有助于防止对未经证实过敏的患者不必要地改变化疗方案，并便于在发生HSR后识别替代治疗方法。在我们中心的实际工作中，过敏专科医生的建议尽可能得以实施，以指导患者护理中的再次暴露策略。
