Diagnostic and predictive value of skin testing in platinum salt hypersensitivity

J Allergy Clin Immunol. 2007 Mar;119(3):726-30. doi: 10.1016/j.jaci.2006.11.640. Epub 2007 Jan 25.


Background: Hypersensitivity reactions to platinum salts are potentially lethal adverse events in chemotherapy, and often require its discontinuation. Several preventive procedures have been proposed: premedication, desensitization regimens, or replacement with a different platinum salt.

Objective: We therefore assessed the value of skin tests with platinum salts. A positive result would confirm their responsibility in hypersensitivity reaction, whereas a negative result would identify candidates for continuation of therapy using a different platinum salt.

Methods: Patch tests, prick tests, and intradermal tests with cisplatin, carboplatin, and oxaliplatin were performed in 21 patients.

Results: Skin tests were positive in 14 of 21 cases. Prick tests were positive in 5 cases with the suspected platinum salt. Intradermal tests were positive in 12 of 19 cases, always when the hypersensitivity occurred less than 2 hours after infusion. Cross-reactions were observed in 4 cases. Delayed readings of skin tests at 24 hours and 48 hours were positive in 3 patients. Patch tests were negative in all the 21 patients tested. Replacement with another platinum salt was performed in 13 patients using one that gave a negative skin test. A relapse of symptoms occurred in 1 patient.

Conclusion: Intradermal tests are particularly indicated for the diagnosis of immediate hypersensitivity reaction. Their good negative predictive value allows safe retreatment by detecting a potential cross-reaction.

Clinical implications: The frequency of cross-reactions among cisplatin, carboplatin, and oxaliplatin has not been clearly established. Skin tests allow different platinum salts to be given and avoid discontinuation of chemotherapy.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / immunology*
  • Carboplatin / immunology
  • Cisplatin / immunology
  • Cross Reactions
  • Drug Hypersensitivity / diagnosis*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Organoplatinum Compounds / immunology
  • Oxaliplatin
  • Platinum / immunology*
  • Prognosis
  • Prospective Studies
  • Salts / immunology*
  • Skin Tests*


  • Antineoplastic Agents
  • Organoplatinum Compounds
  • Salts
  • Oxaliplatin
  • Platinum
  • Carboplatin
  • Cisplatin