Anaphylactoid reaction to carboplatin: successful "desensitization"

Allergol Immunopathol (Madr). 2003 Nov-Dec;31(6):342-4. doi: 10.1016/s0301-0546(03)79209-x.

Abstract

Carboplatin (CP) hypersensitivity reactions have been reported in nearly 12 % of patients treated with this drug. The pathophysiologic mechanisms of these reactions have not been entirely elucidated. Various hypotheses are under discussion. CP hypersensitivity reactions could be IgE-mediated, caused by low-molecular platinum compounds acting as haptens. Platinum salts are also able to release histamine from basophils and mast cells, and some events seem to be non-immune-mediated direct histamine release. We report a case of CP tolerance induction in a 65-year-old man. During the third course of CP he experienced an anaphylactic reaction. Skin testing was negative. Suspecting the possibility of an anaphylactoid reaction due to histamine release, we developed a protocol to induce tolerance. Pre-medication with corticosteroid and antihistaminic was performed before intravenous CP infusion. The bag with CP was first infused 60 ml/h for 30 minutes; the infusion was well tolerated and infusion was continued at 100 ml/h for the next 60 minutes and thereafter at 120 ml/h until the bag was finished. Following this "desensitization", monthly courses of CP using the same protocol have been well tolerated.

MeSH terms

  • Aged
  • Anaphylaxis / chemically induced*
  • Anaphylaxis / therapy
  • Antineoplastic Agents, Alkylating / administration & dosage
  • Antineoplastic Agents, Alkylating / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carboplatin / administration & dosage
  • Carboplatin / adverse effects*
  • Carcinoma / drug therapy
  • Chlorpheniramine / administration & dosage
  • Chlorpheniramine / therapeutic use*
  • Histamine H1 Antagonists / administration & dosage
  • Histamine H1 Antagonists / therapeutic use*
  • Histamine Release / drug effects
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / therapeutic use*
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Infusions, Intravenous
  • Male
  • Methotrexate / administration & dosage
  • Palliative Care
  • Premedication
  • Skin Tests
  • Urologic Neoplasms / drug therapy
  • Vinblastine / administration & dosage

Substances

  • Antineoplastic Agents, Alkylating
  • Histamine H1 Antagonists
  • Immunosuppressive Agents
  • dexchlorpheniramine
  • Chlorpheniramine
  • Vinblastine
  • Carboplatin
  • Hydrocortisone
  • Methotrexate