The Journal of Allergy and Clinical Immunology
Volume 123, Issue 6 , Pages 1262-1267.e1, June 2009

Risk stratification for desensitization of patients with carboplatin hypersensitivity: Clinical presentation and management

  • Paul E. Hesterberg, MD

      Affiliations

    • Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
    • Corresponding Author InformationReprint requests: Paul E. Hesterberg, MD, Allergy Associates, Cox 201, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114.
    • ,
  • Aleena Banerji, MD

      Affiliations

    • Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
    • ,
  • Eyal Oren, MD

      Affiliations

    • Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
    • ,
  • Richard T. Penson, MD

      Affiliations

    • Gillette Center, Massachusetts General Hospital and the Dana Farber Cancer Research Center, Boston, Mass
    • ,
  • Carolyn N. Krasner, MD

      Affiliations

    • Gillette Center, Massachusetts General Hospital and the Dana Farber Cancer Research Center, Boston, Mass
    • ,
  • Michael V. Seiden, MD

      Affiliations

    • Fox Chase Cancer Center, Philadelphia, Pa
    • ,
  • Johnson T. Wong, MD

      Affiliations

    • Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass

Received 2 April 2008; received in revised form 20 February 2009; accepted 26 February 2009.

Background

Women with ovarian cancer treated with chemotherapeutic platinum agents frequently develop hypersensitivity reactions (HSRs). How best to risk-stratify patients for desensitization is uncertain.

Objectives

To evaluate skin test (ST) reactivity to carboplatin in patients with recent and remote histories of carboplatin HSR and to review the relationship between skin test reactivity and tolerance of subsequent carboplatin desensitization.

Methods

Thirty-eight women with carboplatin HSR were evaluated by ST to carboplatin. Thirty women subsequently underwent 106 desensitizations to carboplatin.

Results

Carboplatin ST was positive in 25 of 38 patients (66%). Of patients with recent HSR (<3 months), 20 of 24 (83%) tested positive, whereas 5 of 14 (36%) with remote HSR (>9 months) tested positive (P < .01). Nineteen carboplatin ST+ and 11 ST− patients underwent desensitization to carboplatin. Seven ST+ patients (37%) had mild HSR during desensitization but completed the desensitization with additional treatment or protocol modification. ST− patients with a recent history of HSR (n = 3) tolerated a rapid protocol without HSR and remained ST– with repeated testing. Six of 8 ST− patients (75%) with remote HSR reacted during desensitization. The HSRs were more severe and often associated with an elevated tryptase level. Five of 7 patients retested became ST+ before the second desensitization. Carboplatin desensitization was successfully completed in 105 of 106 (99%) treatment courses.

Conclusions

The timing of carboplatin ST in relation to initial HSR is vital for risk stratification and subsequent desensitization. Initial ST− patients with a remote history of HSR are at high risk for conversion to ST+ and can develop more severe HSR.

Key words: Desensitization, drug allergy, carboplatin, ovarian cancer, skin testing, hypersensitivity

Abbreviations used: HSR, Hypersensitivity reaction, ST, Skin test

 

 Disclosure of potential conflict of interest: A. Banerji has received research support from Lev Pharmaceuticals. E. Oren has served on the speakers' bureau for GlaxoSmithKline and Meda Pharmaceuticals, Inc. R. T. Penson has received research support from Genentech, Inc, DARA Biosciences, Inc, Berlex Laboratories, CuraGen Corp, PDL BioPharma, Imclone Systems Inc, and Endocyte, Inc, and has served as an expert witness for Eli Lilly & Co. C. N. Krasner has received research support from Johnson & Johnson, Genentech, and Fresun. J. T. Wong has served as an expert witness regarding drug infringement. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(09)00498-9

doi:10.1016/j.jaci.2009.02.042

The Journal of Allergy and Clinical Immunology
Volume 123, Issue 6 , Pages 1262-1267.e1, June 2009

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