Skin Tests Useful in Identifying Hypersensitivity to Platinum Salts, Taxanes

By Scott Baltic

February 04, 2020

NEW YORK (Reuters Health) - Skin tests can help identify hypersensitivity to platinum salts and taxanes in cancer patients, according to research from France.

Allergic reactions to these drugs are among the most common side effects of chemotherapy, Dr. Silvie Leroy of the Universite Cote d'Azur, in Nice, and colleagues note in the Journal of Allergy and Clinical Immunology: In Practice.

"With limited anti-neoplastic therapeutic options, being able to accurately identify hypersensitivity is crucial to decrease unnecessary desensitizations," they write. "There is a need for tests with high negative (NPV) and positive predictive values (PPV)."

The researchers report their experience over six years with allergy evaluation of 119 consecutive adult cancer patients who had suspected hypersensitivity to platinum salts or taxanes; 98 were tested for platinum-salt allergy, 20 for taxane allergy, and one for both, all at the University Hospital Center of Nice.

The great majority (92%) of patients showed immediate hypersensitivity, and more than half of these had anaphylaxis. The patients underwent both skin prick tests (SPT) and intradermal tests (ID) for co-treatments, latex, and platinum salts or taxanes as appropriate.

Skin tests showed that 63% of patients had hypersensitivity to platinum salts, 33% to taxanes and 4.2% to concomitant drugs. The negative predictive value (NPV) for the skin test was 100% for taxanes and 92% for platinum salts.

For patients with negative tests for the suspected drug, a graded challenge was suggested to clinicians; for those with a positive test, but negative results for an alternative drug in the same class, a graded challenge using the latter was suggested; and finally, for those with a positive test and no alternative, a seven-step, 330-minute rapid desensitization protocol was suggested.

Fourteen patients were given a graded challenge with taxanes and 50 with platinum salts, demonstrating that "graded challenges can be safely performed by oncology teams trained in anaphylaxis management," the researchers write.

All but two of the 16 patients with a confirmed allergy to a platinum salt were able to undergo desensitization.

Dr. Aleena Banerji, director of the Drug Allergy and Desensitization Program at Massachusetts General Hospital, in Boston, said evaluation and management of patients with reactions or allergies to chemotherapeutics and monoclonal antibodies "is critically important because very often, keeping a patient on the first-line therapy means improved outcomes and a lower mortality rate compared to using second-line agents for many cancers."

"This paper also suggests that when skin testing is negative (because of a small chance of a false-negative result), the patient and allergy team can work with oncology to perform a challenge . . . without using up a lot of resources," Dr. Banerji, who was not involved in the study, told Reuters Health by email.

Dr. Mariana C. Castells, director of the Drug Hypersensitivity and Desensitization Center at Brigham and Women's Hospital, also in Boston, said that over the last 10 years widespread use of both old and new chemotherapy drugs has led to an increase in allergic reactions to these agents.

The new study "provides a time frame for doing skin testing," that is, two weeks after the reaction, she told Reuters Health by email. Doing it earlier can introduce false negatives and put patients at high risk for reactions if they are not desensitized during reintroduction, said Dr. Castells, who also was not involved in the study.

The authors declare that they had no conflicts of interest.

Dr. Leroy could not be reached for comment.

SOURCE: Journal of Allergy and Clinical Immunology: In Practice, online January 7, 2020.