Managing Infusion Reations Before Chemotherapy

Although there is no international data sharing, most chemotherapy drugs cause hypersensitivities reactions (HSRs).  

Chemotherapy drugs have been prescribed for seven decades. Their use has persisted alone or in combination with other antineoplastic agents.

Recent research has shown that the drugs can cause reactions almost immediately, though they can appear hours or days later.

Symptoms often appear on the skin. Among the most common presentations are flushing and/or itching, which can progress to urticaria, angioedema, and widespread erythema. Involvement of the respiratory and/or gastrointestinal tract can follow. Most of the issues are caused by platinum compounds, taxanes, epipodophyllotoxins, and asparaginase. Among platinum compounds, carboplatin is the main compound associated with HSRs. Incidence increases with exposure and affects up to 46% of patients treated with at least seven infusions of the drug. However, reactions don't mean that patients need to opt-out of treatment.  What it means is that Medical Oncologists should be aware of these possible reactions.

Allergists could help with skin testing, risk stratification, desensitization, and possibly with premedication with steroids and antihistamines.

References:

Begum Gorgulu Akin, Merve Erkoc, Elif Tugce Korkmaz, Betul Ozdel Ozturk, Sevgi Colak, Funda Seher Ozalp Ates, Sevim Bavbek, Rapid drug desensitization with platin-based chemotherapy: Analysis of risk factors for breakthrough reactions, World Allergy Organization Journal, 10.1016/j.waojou.2021.100619, 15, 1, (100619), (2022).

Roxana Silvia Bumbacea, Selda Ali, Sabina Loredana Corcea, Luiza Spiru, Cornelia Nitipir, Victor Strambu, Dragos Bumbacea, Omalizumab for successful chemotherapy desensitisation: What we know so far, Clinical and Translational Allergy, 10.1002/clt2.12086, 11, 10, (2021).
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