Taxane re-exposure protocol after initial allergic reaction works

Last Updated: 2016-01-01

By Reuters Staff

NEW YORK (Reuters Health) - Clinicians from Massachusetts have developed an effective strategy to re-introduce taxane therapy after an initial hypersensitivity reaction.

"Risk stratification based on the severity of the initial hypersensitivity reaction and skin testing to guide taxane reintroduction is safe and allows a significant number of patients to resume regular infusions," they report online December 22 in the Journal of Allergy and Clinical Immunology.

Antineoplastics, and taxanes in particular, are a leading cause of fatal drug-induced anaphylaxis in the United States. How best to approach patients with hypersensitivity reactions (HSRs) to taxanes remains unclear.

The protocol developed by Dr. Mariana Castells and colleagues from the Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston involves re-exposing patients to taxanes either through desensitization, challenge, or regular infusion based on the severity of the initial HSR and skin test response.

Depending on the initial risk stratification and tolerance to re-exposure, patients are then treated with shorter desensitization protocols, challenge, or both with the goal of resuming regular infusions, except in patients with a severe immediate initial HSR.

In their paper, Dr. Castells and colleagues report results of a retrospective analysis of a group of patients managed in this fashion for a taxane-related HSR over roughly three years.

Of 138 patients desensitized, 29 (21%) had an immediate HSR and 20 (14%) had a delayed HSR with the protocol; of 49 patients challenged, two (4%) had a mild immediate HSR and one (2%) had a delayed HSR with the protocol.

Importantly, they say no patient had a severe immediate HSR with desensitization or challenge and a significant proportion (36 patients, 22%) were able to resume regular infusions. These patients were more likely to have negative skin test responses and to have had a delayed or mild immediate initial HSR, the researchers say.

They note, "A common finding in many studies on taxane-induced HSRs is the decreasing risk of reaction with repeated exposures. This finding argues for a progressive approach to taxane reintroduction, starting with the safest method for re-exposure (desensitization) when the risk is highest and progressively shortening the protocol or proceeding with challenge with the aim of resuming regular infusions as the risk decreases."

They add, "Although this study raises the possibility of an IgE-mediated mechanism underlying a subset of taxane-induced HSRs, further studies are needed to clarify the mechanisms of these reactions."

SOURCE: http://bit.ly/1UdEcuV

J Allergy Clin Immunol 2015.