Management of chemotherapy hypersensitivity reactions and desensitization: An SGO clinical practice statement

T R Hall; J E MacDonald; K M Bylinowski; E A Alvarez; M M Hardesty; J A Smith

doi:10.1016/j.ygyno.2023.08.017

Management of chemotherapy hypersensitivity reactions and desensitization: An SGO clinical practice statement

Gynecol Oncol. 2023 Oct:177:180-185. doi: 10.1016/j.ygyno.2023.08.017. Epub 2023 Sep 15.

Authors

T R Hall¹, J E MacDonald², K M Bylinowski³, E A Alvarez⁴, M M Hardesty⁵, J A Smith⁶

Affiliations

¹ Baylor College of Medicine, Houston, TX, United States of America. Electronic address: Tracilyn.hall@bcm.edu.
² Medical University of South Carolina, Charleston, SC, United States of America.
³ University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
⁴ University of California - San Francisco, San Francisco, CA, United States of America.
⁵ Alaska Women's Cancer Care, Anchorage, AK, United States of America.
⁶ UT Health McGovern Medical School, Houston, TX, United States of America.

PMID: 37717346
DOI: 10.1016/j.ygyno.2023.08.017

Abstract

Objective: The goal of this practice statement is to help members and their multidisciplinary teams recognize infusion reactions and hypersensitivity reactions in the clinical setting. It will provide recommendations to help guide response to reactions and desensitization when appropriate, to promote safe use of chemotherapeutic agents among all providers in the delivery process.

Methods: A multi-disciplinary team of healthcare professionals from the Society of Gynecologic Oncology Education Committee collaborated to review peer reviewed literature and guidelines to develop a practice statement on the management of chemotherapy hypersensitivity reactions and desensitization regimens.

Results: There is always potential for a patient to have a reaction to any medication, with both infusion reactions and hypersensitivity reactions potentially occurring in the treatment of gynecologic cancers. Premedication to prevent reactions should be given at least prior to infusion for regimens that include the most common agents associated with reactions. At the time when reaction is occurring it might be difficult to distinguish between an infusion reaction versus true hypersensitivity given the similarities in signs and symptoms, therefore it is important that orders to manage reactions be included in every chemotherapy order set so the infusion nurse can provide immediate interventions while waiting for the provider to arrive to assess the patient. Desensitization is a potential option to allow the patient to continue to receive the offending agent. While a variety of desensitization regimens have been presented in the literature, the goal is to minimize steps and variability to decrease opportunity for errors during chemotherapy preparation or administration.

Conclusion: Incorporating a review of the literature and clinical experience from the SGO Education Committee, this paper provides an overview of current approaches for prevention and management of reactions to commonly used chemotherapy agents for gynecologic cancers.

Keywords: Carboplatin; Chemotherapy; Desensitization; Hypersensitivity; Taxanes.