Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations.

BACKGROUND: Although antineoplastic agents are critical in the treatment of cancer, they can potentially cause hypersensitivity reactions that can have serious consequences. When such a reaction occurs, clinicians can either continue the treatment, at the risk of causing a severe or a potentially fatal anaphylactic reaction, or stop the treatment, although it might be the only one available. The objective of the present work was to evaluate the effectiveness of methods used to prevent and treat hypersensitivity reactions to platinum- or taxane-based chemotherapy and to develop evidence-based recommendations. METHODS: The scientific literature published to December 2013, inclusive, was reviewed. RESULTS: Premedication with antihistamines, H2 blockers, and corticosteroids is not effective in preventing hypersensitivity reactions to platinum salts. However, premedication significantly reduces the incidence of hypersensitivity to taxanes. A skin test can generally be performed to screen for patients at risk of developing a severe reaction to platinum salts in the presence of grade 1 or 2 reactions, but skin testing does not appear to be useful for taxanes. A desensitization protocol allows for re-administration of either platinum- or taxane-based chemotherapy to some patients without causing severe hypersensitivity reactions. CONCLUSIONS: Several strategies such as premedication, skin testing, and desensitization protocols are available to potentially allow for administration of platinum- or taxane-based chemotherapy to patients who have had a hypersensitivity reaction and for whom no other treatment options are available. Considering the available evidence, the Comité de l'évolution des pratiques en oncologie made recommendations for clinical practice in Quebec.

Performances of an improved device for skin prick tests.

Every day allergists deal with skin prick testing. Following a recent paper showing that the intravenous needle and the metal lancets are superior to the Stallerpoint® plastic lancet, the manufacturer has improved the device to reach better standards in terms of sensitivity, intra-patient reproducibility and inter-patient reproducibility, as demonstrated on 10 adult patients, comparing the results with skin tests performed with the intravenous needle. We evaluated the sensitivity of the device by calculating the ratio between the number of true-positive tests and the sum of true-positive and false-negative tests. To assess the reproducibility of the test, we calculated the interpatient and the intrapatient coefficient of variation between the mean diameters of the papules induced by the different techniques. The improved device shows performances similar to those obtained with the intravenous needle.

Comparison of five techniques of skin prick tests used routinely in Europe.

BACKGROUND: Skin prick tests represent indispensable tools in allergy, even more than 30 years after their introduction in clinical practice. OBJECTIVES: Few recent European studies have focused on this topic and we thus wanted to compare the instruments most often used today. METHODS: Four instruments were investigated: the 23G intravenous (IV) needle, the ALK Lancet, the Stallergenes (STG) Prick Lancet and the Stallerpoint(®) (using two different methods). Sensitivity, reproducibility, and acceptability were evaluated. In 22 subjects, we calculated the sensitivity and reproducibility (both intra- and interpatient) of these methods by testing the positive control five times. In 50 subjects, we tested the single-blind acceptability of these same five techniques. RESULTS: In terms of sensitivity, the IV needle (100%) and metal lancets (96% for the ALK Lancet and 98% for the STG Prick Lancet) were superior (P < 0.01) to the two Stallerpoint(®) methods (20% and 57%). Intrapatient reproducibility was 16.2%, 14.6%, 15.0%, 97.1% and 18.1%, respectively. The instruments that were best tolerated by the patients were the IV needle and the two metal lancets. CONCLUSION: Metal needles and/or lancets are the tools of choice for skin prick testing.