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.