Diagnosis and management of hypersensitivity reactions related to common cancer chemotherapy agents.
OBJECTIVE
To review clinical hypersensitivity reactions related to common cancer chemotherapy agents and to discuss potential management strategies.


METHODS
PubMed searches were performed for articles published from 1970 to 2008 regarding hypersensitivity to cancer chemotherapy and related agents using the keywords hypersensitivity, allergy, chemotherapy, platinums, taxanes, asparaginase, epipodophyllotoxins, and procarbazine. Retrieved articles were surveyed for additional citations.


METHODS
Articles were reviewed for relevance to the subject matter, and the most pertinent articles were included in this review.


RESULTS
Hypersensitivity reactions are commonly associated with the use of certain cancer chemotherapy drugs, including platinums, taxanes, asparaginase, procarbazine, and epipodophyllotoxins. Platinum agents (cisplatin, carboplatin, oxaliplatin) are associated with IgE-mediated hypersensitivity reactions, and skin testing may be indicated. Taxane (paclitaxel, docetaxel)-related reactions are generally non-IgE mediated, and premedication with corticosteroids and antihistamines is usually effective. Asparaginase has a high rate of hypersensitivity reactions that are likely IgE mediated or related to complement activation. Skin testing has been recommended but has not been validated for asparaginase. Procarbazine reactions can be IgE mediated but are also associated with a type III reaction manifested by pulmonary toxicity and cutaneous reactions. Hypersensitivity reactions related to epipodophyllotoxins may involve both immunologic and nonimmunologic factors that may be avoided with a slow infusion and premedication.


CONCLUSIONS
With the increasing use of cancer chemotherapy agents, hypersensitivity reactions are commonly encountered. Knowledge of the presentations of these reactions and management options give the treating physician the means to make an informed decision of how best to proceed.
Department of Medicine, Division of Allergy and Immunology, VA Greater Los Angeles Healthcare System/University of California Los Angeles, Los Angeles, California 90073, USA. christina.h.lee@hotmail.com
Christina
C
Lee
Mary
M
Gianos
William B
WB
Klaustermeyer
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000276:immunology; D001215:Asparaginase / Q000009:adverse effects / Q000276:immunology; D016190:Carboplatin / Q000009:adverse effects / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D006801:Humans; D009944:Organoplatinum Compounds / Q000009:adverse effects / Q000276:immunology; D000077150:Oxaliplatin; D011034:Podophyllotoxin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000276:immunology; D011344:Procarbazine / Q000009:adverse effects / Q000276:immunology; D043823:Taxoids / Q000009:adverse effects / Q000276:immunology
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D043823:Taxoids; D000077150:Oxaliplatin; D011344:Procarbazine; D016190:Carboplatin; D001215:Asparaginase; D011034:Podophyllotoxin