title: Risk stratification and skin testing to guide re-exposure in taxane-induced hypersensitivity reactions.
abstract: BACKGROUND
  The optimal approach to patients with hypersensitivity reactions (HSRs) to taxanes has not been established.
  
  
  OBJECTIVE
  We sought to assess the safety and efficacy of risk stratification based on the severity of the initial HSR and skin testing for guiding taxane reintroduction in patients with an HSR to these agents.
  
  
  METHODS
  Data on 164 patients treated for a taxane-related HSR from April 2011 to August 2014 at the Dana-Farber Cancer Institute and Brigham and Women's Hospital were collected retrospectively. Patients were re-exposed to taxanes either through desensitization, challenge, or regular infusion based on the severity of the initial HSR and skin test response. Depending on the initial risk stratification and tolerance to re-exposure, patients were then treated with shorter desensitization protocols, challenge, or both with the aim of resuming regular infusions, except in patients with a severe immediate initial HSR.
  
  
  RESULTS
  Of 138 patients desensitized, 29 (21%) had an immediate and 20 (14%) had a delayed HSR with the procedure. Of 49 patients challenged, 2 (4%) had a mild immediate and 1 (2%) had a delayed HSR with the procedure. No patients had a severe immediate HSR with desensitization or challenge. Thirty-six (22%) patients eventually resumed regular infusions. These patients were more likely to have negative skin test responses and to have experienced a delayed or mild immediate initial HSR.
  
  
  CONCLUSIONS
  Risk stratification based on the severity of the initial HSR and skin testing to guide taxane reintroduction is safe and allows a significant number of patients to resume regular infusions.
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Picard
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Leyla
authors.initials: L
authors.lastname: Pur
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Joana
authors.initials: J
authors.lastname: Caiado
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Pedro
authors.initials: P
authors.lastname: Giavina-Bianchi
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Violeta Regnier
authors.initials: VR
authors.lastname: Galvão
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass.
authors.forename: Suzanne T
authors.initials: ST
authors.lastname: Berlin
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass.
authors.forename: Susana M
authors.initials: SM
authors.lastname: Campos
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass.
authors.forename: Ursula A
authors.initials: UA
authors.lastname: Matulonis
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass. Electronic address: mcastells@partners.org.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Castells
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D000077143:Docetaxel; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012882:Skin Tests; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel
keywords: Taxane; allergy; challenge; desensitization; docetaxel; hypersensitivity; paclitaxel; risk stratification; skin test