Relationship between a history of systemic allergic reactions and risk of subsequent carboplatin hypersensitivity.
OBJECTIVE
The establishment of clinical features identifying patients at a heightened risk for the development of carboplatin hypersensitivity may assist in the management of this important toxicity. Based on a previous report suggesting a history of "bee sting" allergy predicted for paclitaxel hypersensitivity, we attempted to determine if there was a relationship between a history of prior systemic allergic reactions and the subsequent development of carboplatin hypersensitivity.


METHODS
The medical records of all women treated in the Gynecologic Cancer Program of the Cleveland Clinic from June 1995 to May 2002 who received >6 cycles of platinum-based chemotherapy were retrospectively reviewed for a history of prior systemic hypersensitivity (e.g., medications, environmental exposure). The incidence of "positive" allergic histories was then examined in relation to the subsequent risk of patients developing either a documented carboplatin hypersensitivity reaction or a "positive" carboplatin skin test.


RESULTS
The analysis included 174 patients (91 undergoing "carboplatin skin testing") who received > 6 courses of carboplatin. Of 53 patients with no recorded history of systemic hypersensitivity treated prior to our routine use of carboplatin skin testing, 19% experienced an allergic reaction, in contrast to a 40% incidence of a documented carboplatin reaction in 30 patients with a recorded history of hypersensitivity to a medication or environmental exposure (P < 0.05). For the 55 patients with no history of systemic hypersensitivity who underwent carboplatin skin-testing, 27% had a positive test result, in comparison to a 36% positive test rate in women with a previous history of a systemic hypersensitivity reaction recorded in the medical record (P > 0.05).


CONCLUSIONS
This analysis suggests that patients with a prior history of systemic hypersensitivity to medications or environmental exposures may be at a heightened risk for experiencing allergic reactions to carboplatin.
Markman
Margaret
M
Department of Hematology/Medical Oncology, the Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Zanotti
Kristine
K
Kulp
Barbara
B
Peterson
Gertrude
G
Markman
Maurie
M
D000707:Anaphylaxis / Q000139:chemically induced / Q000276:immunology; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016190:Carboplatin / Q000009:adverse effects* / Q000627:therapeutic use; D004198:Disease Susceptibility / Q000276:immunology; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000276:immunology; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology*; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D016190:Carboplatin