title: A protocol for risk stratification of patients with carboplatin-induced hypersensitivity reactions.
abstract: BACKGROUND
  Management of patients with carboplatin-induced hypersensitivity reactions (HSR) has been complicated by high false-negative rates of carboplatin skin test (ST) results. These patients might be at risk for future carboplatin-induced HSRs. In this article we identify a strategy to improve risk stratification of patients with a history of carboplatin-induced HSRs by using a protocol that includes repeat skin testing and drug desensitization.
  
  
  OBJECTIVE
  We sought to identify a management strategy for patients with a history of carboplatin-induced HSRs with negative carboplatin ST results.
  
  
  METHODS
  From 2008-2010, patients with carboplatin-induced HSR underwent risk stratification per a protocol using 3 repeat STs with intervening drug desensitizations.
  
  
  RESULTS
  Of the 44 patients with carboplatin-induced HSRs, 39 completed the protocol. Patients were classified as having positive ST results (n = 16), having negative ST results (n = 11), or ST converters when the ST result converted to positive after an initial negative result (n = 12). ST converters are more likely to have HSRs during subsequent desensitizations than patients with negative ST results (56.1% vs 4.5%, P < .001). ST converters had a significantly longer time interval between their initial HSR and initial ST evaluation compared with either patients with true-negative ST results (22.1 vs 6.0 months, P = .03) or patients with positive ST results (22.1 vs 1.8 months, P = .001).
  
  
  CONCLUSIONS
  Our experience suggests that repeat STs are necessary for risk stratification in patients with a remote clinical history of HSR and an initial negative ST result because there is a significant rate of conversion to a positive ST result. ST converters have an increased risk of HSRs during subsequent carboplatin treatment.
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass, USA. spatil35@partners.org
authors.forename: Sarita U
authors.initials: SU
authors.lastname: Patil
authors.forename: Aidan A
authors.initials: AA
authors.lastname: Long
authors.forename: Morris
authors.initials: M
authors.lastname: Ling
authors.forename: Michael T
authors.initials: MT
authors.lastname: Wilson
authors.forename: Paul
authors.initials: P
authors.lastname: Hesterberg
authors.forename: Johnson T
authors.initials: JT
authors.lastname: Wong
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
mesh_terms: D016190:Carboplatin / Q000009:adverse effects* / Q000276:immunology; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D012882:Skin Tests
chemical_list: D016190:Carboplatin