Table of contents
Hypersensitivity reactions to chemotherapy
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of hypersensitivity reactions to chemotherapy are prepared by our editorial team based on guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI 2022), the European Academy of Allergy and Clinical Immunology (EAACI 2022), the European Society of Medical Oncology (ESMO 2017), the Comité de l'évolution de la pratique en ...
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Screening and diagnosis
Pathogenesis: as per EAACI 2022 guidelines, recognize the pathogenetic mechanisms of hypersensitivity reactions to different chemotherapeutic agents:
Situation
Guidance
Platinum compounds
IgE-mediated reactions in some immediate, often severe cases
B
Taxanes
Direct activation of complement system by the drug in the majority of cases
IgE-mediated reactions in some cases
B
Epipodophyllotoxins
Immunologic and non-immunologic mechanisms
B
Classification and risk stratification
Risk factors: as per ESMO 2017 guidelines, take into account other risk factors apart from being aware of the potential risk of an infusion reaction of a specific drug, when delivering anticancer drugs, and during which course it is most likely to happen.
B
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Severity grading
Diagnostic investigations
Skin testing: as per EAACI 2022 guidelines, recognize that skin testing is the most readily available diagnostic test.
B
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Drug provocation test
In vitro IgE testing
Tryptase and histamine tests
Medical management
Observation
As per ESMO 2017 guidelines:
Recognize that prompt recognition and immediate medical attention are essential.
⁄
Recognize that some patients feel odd or uncomfortable or express a need to urinate or defecate before an infusion reaction. Pay serious attention to those symptoms and evaluate the patient by measuring BP and pulse rate.
B
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Initial supportive therapy
Management of anaphylaxis
Drug desensitization
Nonpharmacologic interventions
Psychological support
As per ESMO 2017 guidelines:
Provide psychological intervention to alleviate symptoms of uncertainty related to a potential infusion reaction with anticancer drugs.
B
Provide psychological support and have a complete, informative discussion with the patient about the potential benefits of continuing with the drug and the risk of infusion reaction recurrence.
B
Specific circumstances
Preventative measures
Preparation before drug delivery: as per ESMO 2017 guidelines, elicit a medical history, ask about previous allergic disorders, atopic status and concomitant treatments before the administration of any drug.
B
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Premedication
Rate of administration
Prevention of future episodes
Follow-up and surveillance
Post-reaction monitoring: as per ESMO 2017 guidelines, obtain close observation for 24 hours after a severe reaction. Monitor vital signs and control recurrence symptoms.
B
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Rechallenge