Rapid drug desensitization with chemotherapy: when should omalizumab be considered?

IF 2.1 4区 医学 Q3 ALLERGY
Allergologia et immunopathologia Pub Date : 2025-07-01 eCollection Date: 2025-01-01 DOI:10.15586/aei.v53i4.1349
İsmet Bulut, Zeynep Yegin Katran
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引用次数: 0

Abstract

Background: All chemotherapy agents have the potential risk of developing hypersensitivity reactions (HSRs). In patients who develop HSRs, rapid drug desensitization (RDD) enables the use of a treatment option that prevents disease progression. If RDD fails to elicit the desired results or in patients with baseline HSRs Brown grades 2-3, omalizumab may also be a treatment option. Our primary aim is to share the demographic and clinical characteristics of our patients who underwent RDD. Our secondary aim is to share our experience with omalizumab during RDD in difficult cases.

Methods: This was a retrospective study of patients with immediate-HSRs to chemotherapeutic (CHT) agents. Initial HSRs were classified as grades 1, 2, or 3 based on severity. Prick/intradermal skin tests were performed with implicated agents. In grade 3 reactions and skin prick test (SPT)-positive patients, a 16-step desensitization was applied. A 12-step desensitization was applied in other patients. In 10 patients, omalizumab was administered for premedication.

Results: The study analyzed data from 80 patients (F/M: 60/20). The number of patients who received different medictions was as follows: carboplatin-23, paclitaxel-22, oxaliplatin-21, dasotaxel-9, etoposide-1, docorubicin-1, pertuzimab-1, paclitaxel+herceptin-1, and bevacizumab+oxaliplatin-1. Inıtıal HSRs were grade 1: 27(%33,7) , grade 2: 30 (%37,5), and grade 3: 23(% 28,7). A total of 22 patients (27.5 %) had atopy based on SPT. Skin tests with implicated agents were done on 78 patients. For the inıtial HSR grades 1, 2, and 3, the number of positive skin test responses was 25/27, 27/29, and 17/22, respectively. A total of 377 RDDs were performed completely, but 22 patients developed 3 reactions during RDD (grade 1: 77.2%, grade 2: 13.6%, and grade 3 9%). All patients received a mean of 4.7 (minimum: 1, maximum: 23) RDDs. There was no statistical difference in the severity of reaction, system involvement, and distribution of symptoms between platinum and taxanes groups. The rate of reaction during RDD was higher in patients receiving platinum compared with taxan. Ten patients received omalizumab before RDD. Initial HSRs were grade 3 in 8 patients; the responsible agent was platinum in 5 patients; and 1 patient developed grade 3 HSR during RDD. In four patients, ınıtıal HSRs were grades 2 and 3, and desensitization was not continued when HSR developed during RDD. A total of 373 successful RDDs were performed.

Conclusions: RDD is a very important treatment applied to patients with immediate-HSRs to CHT agents. Omalizumab facilitated the continuation of chemotherapy in patients with index reaction grades 2-3. It provided an opportunity for 8 of 10 patients with Grade 2-3 severe reactions to continue treatment. In our population, 98.9% (373/377) successful completion of RDDs in all chemotherapy groups demonstrates the safety of this procedure.

化疗的快速药物脱敏:什么时候应该考虑使用omalizumab ?
背景:所有化疗药物都有发生超敏反应(HSRs)的潜在风险。在发生HSRs的患者中,快速药物脱敏(RDD)可以使用一种预防疾病进展的治疗方案。如果RDD未能获得预期结果或基线HSRs Brown分级为2-3的患者,omalizumab也可能是一种治疗选择。我们的主要目的是分享我们的RDD患者的人口学和临床特征。我们的第二个目标是分享我们在困难病例RDD期间使用omalizumab的经验。方法:这是一项对化疗(CHT)药物立即hsrs患者的回顾性研究。最初的hsr根据严重程度分为1级、2级或3级。用相关试剂进行点刺/皮内皮肤试验。对于3级反应和皮肤点刺试验(SPT)阳性的患者,应用16步脱敏。其他患者采用12步脱敏治疗。在10例患者中,使用omalizumab作为预用药。结果:本研究分析了80例患者的数据(F/M: 60/20)。接受不同药物治疗的患者数量为:卡铂-23、紫杉醇-22、奥沙利铂-21、dasotaxel-9、依托泊苷-1、多红霉素-1、pertuzimab-1、紫杉醇+赫赛汀-1、贝伐单抗+奥沙利铂-1。Inıtıal HSRs为1级27(%33,7),2级30(%37,5)和3级23(% 28,7)。共有22例(27.5%)患者发生基于SPT的特应性反应。对78名患者进行了涉及试剂的皮肤试验。对于inıtial HSR等级1、2、3,皮试阳性反应数分别为25/27、27/29、17/22。总共377例患者完成了RDD,但22例患者在RDD期间出现了3次反应(1级:77.2%,2级:13.6%,3级9%)。所有患者的rdd平均为4.7(最小1,最大23)。铂组和紫杉烷组在反应的严重程度、系统受累程度和症状分布方面没有统计学差异。与紫杉相比,接受铂治疗的患者在RDD期间的反应率更高。10例患者在RDD前接受了omalizumab治疗。8例患者初始hsr为3级;5例患者的主要用药为铂;1例患者在RDD期间发生3级HSR。在4例患者中,ınıtıal HSR为2级和3级,并且在RDD期间发生HSR时未继续脱敏。总共进行了373例成功的rdd。结论:RDD是一种非常重要的治疗方法,适用于对CHT药物立即hsrs的患者。Omalizumab促进指数反应等级为2-3的患者继续化疗。它为10例2-3级严重反应患者中的8例提供了继续治疗的机会。在我们的人群中,在所有化疗组中,98.9%(373/377)成功完成了rdd,这表明了该方法的安全性。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
131
审稿时长
6-12 weeks
期刊介绍: Founded in 1972 by Professor A. Oehling, Allergologia et Immunopathologia is a forum for those working in the field of pediatric asthma, allergy and immunology. Manuscripts related to clinical, epidemiological and experimental allergy and immunopathology related to childhood will be considered for publication. Allergologia et Immunopathologia is the official journal of the Spanish Society of Pediatric Allergy and Clinical Immunology (SEICAP) and also of the Latin American Society of Immunodeficiencies (LASID). It has and independent international Editorial Committee which submits received papers for peer-reviewing by international experts. The journal accepts original and review articles from all over the world, together with consensus statements from the aforementioned societies. Occasionally, the opinion of an expert on a burning topic is published in the "Point of View" section. Letters to the Editor on previously published papers are welcomed. Allergologia et Immunopathologia publishes 6 issues per year and is included in the major databases such as Pubmed, Scopus, Web of Knowledge, etc.
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