Prevention and management of antineoplastic-induced hypersensitivity reactions

Acute hypersensitivity reactions (HSRs) are an unpredictable and potentiall y catastrophic complication of treatment with chemotherapeutic agents. Reac tions may affect any organ system in the body and range widely in severity from mild pruritus to systemic anaphylaxis. Certain classes of chemotherape utic agents, such as the taxanes, platinum compounds, asparaginases, and ep ipodophyllotoxins are commonly associated with HSRs. The clinical character istics of these high risk agents with respect to HSRs are discussed in this review. Protocols to prevent or reduce the severity of these reactions have been de veloped, but despite these attempts, HSRs will still happen. Should a react ion occur, it is imperative that it be recognised quickly in order to minim ise exposure to the inciting agent and implement appropriate therapeutic an d supportive measures. When a patient becomes sensitised to a chemotherapeu tic agent, avoidance of re-exposure is the mainstay of future prevention. F or sensitised patients who have derived clinically meaningful benefit from a particular agent, however, continuation of treatment with the agent is de sirable. Options may include attempting a trial of desensitisation or treat ment with a related compound. Virtually all patients demonstrating HSRs to paclitaxel and docetaxel are able to successfully tolerate re-treatment fol lowing discontinuation and administration of diphenhydramine and hydrocorti sone. Re-treatment has generally been less successful with platinum compoun ds, with recurrent HSRs. occurring in up to 50% of patients following desen sitisation protocols. Patients sensitised to asparaginase are often able to tolerate the alternative preparations, Erwinia carotovora asparaginase or polyethylene glycol-modified Escherichia coli asparaginase. There is very l ittle experience with re-treatment following sensitisation to the epipodoph yllotoxins. As re-treatment may have serious consequences, careful consider ation of the risks and benefits of these strategies is imperative when deci ding among these options.