Anaphylactoid reaction to carboplatin: successful "desensitization".
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.
Moreno-Ancillo
A
A
Unidad de Alergia, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain. alanaro@telefonica.es
Domínguez-Noche
C
C
Gil-Adrados
A C
AC
Cosmes
P M
PM
Duarte
I
I
Mateos
Y
Y
D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced* / Q000628:therapy; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects*; D002277:Carcinoma / Q000188:drug therapy; D002744:Chlorpheniramine / Q000008:administration & dosage / Q000627:therapeutic use*; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006636:Histamine Release / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D010166:Palliative Care; D011292:Premedication; D012882:Skin Tests; D014571:Urologic Neoplasms / Q000188:drug therapy; D014747:Vinblastine / Q000008:administration & dosage
D018906:Antineoplastic Agents, Alkylating; D006634:Histamine H1 Antagonists; D007166:Immunosuppressive Agents; C018904:dexchlorpheniramine; D002744:Chlorpheniramine; D014747:Vinblastine; D016190:Carboplatin; D006854:Hydrocortisone; D008727:Methotrexate